Biographic  Clinics 


DeQUINCEY      carlyle 


DARWIN 


HUXLEY 


BROWNING 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 


BIOGRAPHIC  CLINICS 


GOULD 


Thomas  De  Quincey. 


Biographic  Clinics 


The  Origin  of  the  Ill-Health 

OF 

De  Quincey,  Carlyle,  Darwin,  Huxley 
AND  Browning 


BY 

GEORGE  M.  GOULD,  M.D., 

Editor  of  American  Medicine,  Author  of  "  An  Illustrated  Dictionary  of  Medicine, 

Biology,  etc.,"  "  Borderland  Studies,"  "  The  Meaning  and 

Method  of  Life."  etc. 


PHILADELPHIA 

P.   BLAKISTON'S  SON  &  CO. 

I0I2  Walnut  Street 

1903 


Copyright,  1902,  by 
GEORGE  M.  GOULD,  M.D. 


}.-    t    r 

HOB 

"  The  improver  of  natural  knowledge  absolutely  refuses  to 
acknowledge  authority,  as  such.  For  him,  skepticism  is  the 
highest  of  duties;  blind  faith  the  one  unpardonable  sin.  And 
it  cannot  be  otherwise,  for  every  great  advance  in  natural 
knowledge  has  involved  the  absolute  rejection  of  authority, 
the  cherishing  of  the  keenest  skepticism,  the  annihilation  of 
the  spirit  of  blind  faith;  and  the  most  ardent  votary  of  sci- 
ence holds  his  firmest  convictions  because  his  experience  teaches 
him  that  whenever  he  chooses  to  bring  these  convictions  into 
contact  with  their  primary  source.  Nature — whenever  he 
thinks  fit  to  test  them  by  appealing  to  experiment  and  to  ob- 
servation— Nature  will  confirm  them.  The  man  of  science  has 
learned  to  believe  in  justification,  not  by  faith  but  by  verifica- 
tion."— Huxley,  Advisableness  of  Improving  Natural  Knowl- 
edge. 

"He  that  can  abolish  pain,  relieve  his  fellow  mortal  from 
sickness,  he  is  indisputably  usefullest  of  all  men.  Him  savage 
and  civilized  will  honor.  As  a  Lord  Chancellor  under  one's 
horsehair  wig  there  might  be  misgivings,  still  more  so,  perhaps, 
as  a  Lord  Primate  under  one's  cauliflower,  but  if  I  could  heal 
disease  I  should  say  to  all  men  and  angels  without  fear  *  En ! 
Ecce ! ' " — Carlyle. 

"  H  by  gaining  knowledge  we  destroy  our  health  we  labor 
for  a  thing  that  will  be  useless  in  our  hands." — Bacon. 


Gy57'?6 


V\«rv>rt 


TABLE    OF    CONTENTS. 

Page. 

INTRODUCTION 9 

^  CHAPTER  I.    De  Quincey 15 

>  CHAPTER  11.    Carlyle 41 

-t   CHAPTER  III.    Darwin 77 

f  CHAPTER  IV.    Huxley 107 

/  CHAPTER  V.    Browning 125 

CHAPTER  VI.  Biliousness    and    Headache       .  141 

CHAPTER    VII.    Some    Neglected    Points    in    the 

Physiology  of  Vision       .       .        157 

CHAPTER  VIII.    The  Discovery  of  Astigmatism  and 

Eyestrain 171 

CHAPTER     IX.    Responsibilities      ....        197 


INTRODUCTION. 

Medical  science  and  art  has  heretofore  busied  itself 
with  three  aspects  or  phases  of  disease : 

1.  With  the  patient's  complaint  upon  the  day  of  con- 
sultation, or  during  the  time  of  the  special  illness. 
Rightly  but  crudely  the  primary  function  of  the  physi- 
cian is  held  to  be  to  get  the  patient  over  his  present 
trouble  and  let  the  future  take  care  of  the  future  illness. 
The  average  physician  will  hardly  recognize  the  remote 
causes  which  brought  about  the  present  disease,  its 
far-off  results,  and  the  multiform  relations  of  this 
special  condition  with  others,  physiologic  and  patho- 
logic, and  with  the  habits,  duties,  and  necessities  of 
social  life;  even  if  these  subtle  causes  and  relations 
were  sought  and  considered  the  patient  would  not 
recognize  nor  appreciate  the  service,  and  certainly 
would  not  pay  for  it.  "  Make  me  well  again  and 
quickly,"  is  his  sole  demand,  and  hence  this  must  be  the 
physician's  task. 

2.  When  the  physician  has  succeeded,  or  perhaps  has 
failed,  in  this  special  duty,  he  thinks  how  he  may  treat 
other  patients  suffering  from  the  same  complaint,  and 
he  writes  of  his  experience  and  of  his  success  or  fail- 

2  9 


lo  BIOGRAPHIC    CLINICS. 

ure,  in  such  cases,  always  concerning  the  single  disease 
in  question  and  its  cure.  Again,  the  infinite  variety  of 
pathologic  origin,  and,  as  affecting  different  patients, 
the  relationship  of  the  special  disease  to  the  entire  life 
of  the  patient,  are  not  thought  of. 

3.  The  philosophic  physician  and  the  pathologist 
seek  to  learn  the  pathogeny  of  a  single  type  or  kind 
of  disease,  as  of  tuberculosis,  syphilis,  etc.,  apart 
from  all  individual  origin  and  relations.  The  suffer- 
ing, even  the  existence,  of  the  individual  patient  is  not 
in  the  attention. 

Necessary  and  wise  as  are  these  aspects  and  duties, 
there  is  a  fourth  professional  obligation  quite  as  im- 
portant as  the  three,  scientifically  even  more  so,  which 
we  have  entirely  ignored.  To  its  consideration  we 
must  in  the  future  devote  our  attention  to  an  increas- 
ing degree,  and  in  doing  so  we  shall  unexpectedly 
benefit  the  patient  and  the  world.  In  this  work,  too, 
we  shall  gain  professional  power  and  honor  and  bring 
back  to  his  splendid  function  the  almost  extinguished 
family  physician,  or  general  practitioner.  I  allude  to 
the  patient's  life-problem,  the  duty  of  studying  the  life 
as  a  whole,  all  of  his  diseases,  past,  present,  and  to 
come,  and  what  relation  they  bear  to  his  life  and 
sociologic  conditions.  This  clinical  life-problem  per- 
taining to  the  diseases,  disabilities,  and  entire  career  of 
life,  will  in  time  surely  come  to  interest  more  and 
jnore,  as  '*  the  problem  of  the  future "  becomes  of 


INTRODUCTION.  n 

greater  interest  to  each  one,  and  to  science  as  a  whole. 
Such  a  consideration  of  a  man's  entire  life  and  how 
disease  conditions  it,  is  primarily  a  historical  study. 
It  is  true  that  such  a  study  is  impossible  with  many  of 
our  patients,  because  they  sometimes  live  as  long  as  we 
do,  or  longer;  but  even  here  this  want  is  filled  by  a 
careful  study  of  the  family  history  and  ancestors, 
of  the  past  personal  history,  and  of  present  conditions. 
Science  is  accurate  knowledge  and  foreknowledge,  and 
as  our  medical  science  improves  in  accuracy,  we,  like 
the  paleontologist,  are  more  and  more  able  to  recon- 
struct the  picture  of  the  entire  organism  and  its  essen- 
tial history  from  a  single  relic,  as,  e.  g.,  a  bone  or  a 
tooth.  The  patient  before  us  is  a  history  and  a 
prophecy.  But  the  method  of  thus  historically  envisag- 
ing and  massing  the  life-work  and  life-difficulty,  can 
best  be  suggested  and  illustrated  by  the  medical  de- 
scription of  past  lives.  This,  so  far  as  I  know,  has 
never  been  done,  at  least  with  scientific  thoroughness 
and  sociologic  largeness  of  view.  Mere  hints  of  such 
a  method,  so  far  as  I  have  any  medical  knowledge  to 
warrant  it,  I  have  sought  to  give  in  these  sketches  of 
the  medical  facts  of  the  lives  of  De  Quincey,  Carlyle, 
Darwin,  Huxley,  and  Browning.  Manifest  imperfec- 
tions are  largely  excusable  on  the  ground  of  an  almost 
utter  lack  of  clinical  data.  We  are  able  to  do  no  more 
than  catch  glimpses,  faint  and  fleeting,  of  the  facts 
through    the    incidental,    unintended,    and    medically 


12  BIOGRAPHIC    CLINICS. 

crude  allusions  of  friends,  or  of  the  poor  patients  as 
they  groan  and  sigh  under  the  load  of  their  uncom- 
prehended  afflictions.  Like  flashes  of  lightning  of  the 
past  storm  these  reveal  for  an  instant  the  whole  land- 
scape of  their  time  and  work  and  suffering.  Such 
swift  visions  can  only  be  made  scientific  through  a  sys- 
tematic and  periodic  study  of  the  physiologic  and 
medical  tests  of  patients  during  their  whole  lives.^ 
Clinics  should  be  held  on  the  entire  life  of  the  patient, 
and  until  this  is  scientifically  possible  by  a  system  of 
biologic  and  clinical  examinations,  we  must  glean  our 
pitiful  aftermath  from  the  biographies  and  letters,  etc. 
The  million  case-records  left  by  dead  physicians  are 
either  worthless  or  lost,  as  these  possibly  most  precious 
clinical  data  are  considered  of  no  value. 

The  forelying  study  of  the  clinical  biographies  of 
five  of  the  greatest  geniuses  of  England  concerns  but 
one  class  of  symptoms  and  one  disease-producing 
factor.  Of  other  diseases  and  other  patients  I  am  not 
competent  to  speak.  The  field  will  be  found  untilled 
and  productive  by  specialists  in  other  departments  in 
medicine.  But  to  the  historian  and  psychologist  the 
role  of  eyestrain  will  be  especially  interesting  because 

^The  outline  of  the  objects  and  methods  of  such  biologic 
and  pathologic  life-studies  I  have  given  in  an  address,  en- 
titled, "A  System  of  Personal  Biologic  Examinations  the 
Condition  of  Adequate  Medical  and  Scientific  Conduct  of 
Life,"  Jour.  Am.  Med.  Assoc,  July  21,   1900. 


INTRODUCTION.  13 

of  its  subtle  and  astonishing  influence  upon  character, 
upon  literature,  and  even  upon  history.  None  could 
pretend  to  a  fraction  of  the  insight  which  could  see  the 
profound  differences  in  our  literature  and  civilization 
consequent  upon  the  injection  of  the  eye-strain  factor. 
What  could  these  men  not  have  done,  what  would  they 
not  have  done,  if  this  morbidizing  horror  had  not 
clutched  their  hearts  with  its  palsying  and  despoiling 
hand?  Certainly  also  every  tenth  person  of  the  slaves 
of  civilization,  all  those  who  are  compelled  to  work 
with  their  eyes  at  the  reading,  writing,  and  handwork 
distance,  are  to-day  having  havoc  played  with  their 
minds,  dispositions,  and  workaday  lives,  by  this  un- 
recognized disease  factor.  I  am  told  that  an  abnor- 
mally large  percentage  of  criminals  and  the  youth  con- 
signed to  reformatories  have  high  degrees  of  optical 
and  other  defects  of  the  eyes.  Out  of  68  cases  of 
epileptics  examined,  98  percent  had  astigmatism,  and 
50  percent  had  the  very  rare  and  most  injurious 
defect,  unsymmetric  astigmatism.  There  is  no  con- 
siderable part  or  kind  of  our  social  life,  the  drink- 
problem,  the  labor-problem,  all  handicrafts,  family 
tragedies,  etc.,  in  which  the  subtle  influence  of  morbid 
vision  is  not  at  its  oflice  of  evil. 

Whether  physiologic  or  pathologic,  the  eye  is  neces- 
sarily actively  functional  during  every  instant  of  the 
waking  life.  It  is  bound  up  with  every  emotion  and 
guides  every  concept.  Our  thinking  is  by  photographic 


14  BIOGRAPHIC    CLINICS. 

images;  even  the  letters  of  the  alphabet  are  conven- 
tionalized pictures.  When  vision  is  morbid  there  is 
therefore  no  limit  to  the  kind  and  extent  of  resultant 
harm  both  to  the  organism  and  to  the  life. 


DE  QUINCEY. 


CHAPTER  I. 

THOMAS   DE   QUINCEY. 

The  principal  clinical  facts  I  have  been  able  to 
gather  from  the  biography  and  letters  of  De  Quincey 
are  epitomized  in  the  following  notes  and  quotations: 

He  was  born  August  15,  1785. 

He  was,  at  14,  "a  boyish  and  energetic  character." 

At  14  years  of  age,  he  was  probably  the  best  Greek  scholar 
in  Europe,  conversing  in  that  language  fluently.  His  Latin 
verses  were  paraded  as  models  by  his  teachers  before  the  older 
boys.  His  passion  for  books  was  so  great  that  he  went  heavily 
in  debt  for  them  beyond  his  allowance. 

He  had  to  be  removed  from  school  at  the  age  of  14  or  15, 
"  in  consequence  of  a  very  alarming  illness  threatening  his 
head,"  which  lasted  more  than  a  year.  A  slight  blow  on  the 
head  while  at  school  was  erroneously  spoken  of  as  the  cause  of 
his  illness. 

Good  spirits  returned  but  he  continued  to  suffer  much  at 
intervals  from  pain  in  the  head. 

"As  to  health,  I  may  say  fairly  that  I  have  not  passed  one 
quarter  of  the  time  I  have  been  at  this  school  in  health.  I 
have  not,  it  is  true,  been  seriously  ill,  but  I  have  been,  what  is 
to  me  worse, — weary  and  torpid  and  languid."  He  complains 
chiefly  of  want  of  exercise.     (This  was  at  the  age  of  16.) 

At  the  age  of  17  he  could  endure  it  no  longer;  he  borrowed 
some  money  and  ran  away  to  Wales,  where  he  carried  a  tent, 
wandered  about,  sleeping  in  the  open  air,  sometimes  living  on 
"blackberries,  hips,  and  haws,"  and  random  hospitality.  His 
health  improved,  but  his  money  failed  and  he  came  to  London. 


i8  BIOGRAPHIC    CLINICS. 

His  life  there  is  told  in  the  first  section  of  the  "confessions." 
"About  1802  a  hideous  sensation  began  to  haunt  me  as 
soon  as  I  fell  into  a  slumber,  which  has  since  returned  upon 
me  at  different  periods  of  my  life — viz.,  a  sort  of  twitching 
(I  knew  not  where,  but  apparently  about  the  region  of  the 
stomach)  which  compelled  me  violently  to  throw  out  my  feet 
for  the  sake  of  relieving  it.  This  sensation  coming  on  as 
soon  as  I  began  to  sleep,  and  the  effort  to  relieve  it  constantly 
awaking  me,  at  length  I  slept  only  from  exhaustion,  and, 
through  increasing  weakness,  I  was  constantly  falling  asleep 
and  constantly  awaking." 

He  consented  to  study  at  Oxford,  but  in  the  second  year, 
(1804)  he  "had  been  suffering  severely  from  a  neuralgic 
affection " ;  opium  was  recommended  by  a  college  friend, 
and  in  it  he  discovered  "  a  panacea  "  as  he  exclaims,  "  for  all 
human  woes."  He  was  for  some  years  "an  occasional  rather 
than  a  constant  devotee"  of  the  drug. 

"  His  love  of  roaming  over  the  hills  and  valleys "  was 
noticeable.  He  disappeared  from  Oxford,  and  after  some  years 
of  travel,  etc.,  he  settled  at  Grasmere  in  1809,  aged  24. 

"  He  was  capable  of  undergoing  great  fatigue  and  took 
constant  exercise." 

"  He  loved  long  walks,  and  had  a  keen  interest  in  sport." 
He  walked  much  at  night. 

"  In  1812  I  suffered  an  attack  of  nervous  horror  which  lasted 
for  five  months,  and  which  went  off  in  one  night  as  unac- 
countably as  it  had  first  come  on  in  one  second  of  time." 

In  1813  the  irritation  of  the  stomach  recurred  with  such  in- 
tensity that  he  increased  the  doses  of  opium  he  had  been  taking 
intermittently  since  1804. 

He  now  took  340  grains  of  opium  or  8,000  drops  of  laud- 
anum a  day,  a  little  more  than  half  what  Coleridge  was  taking 
at  the  same  time. 

In  1814  he  reduced  the  dose  to  40  grains  a  day,  and  in  1816 
he  felt  he  had  so  conquered  the  habit  that  he  could  marry. 

In  1817-18  he  grew  worse,  was  in  a  bad  way,  and  there  was 
an  increase  of  the  opium  again. 


THOMAS   De    QUINCEY.  19 

In  1821  he  conquered  the  habit  again,  but  he  became  "  ill," 
"depressed  in  spirits,"  "dejected,"  "the  liver  deranged,"  with 
"  derangement  of  the  liver,"  etc.,  and  in  1823-24  he  again  fell 
under  the  sway  of  opium. 

In  1825  he  wrote:  "I  am  quite  free  of  opium,  but  it  has 
left  the  liver,  which  is  the  Achilles  heel  of  almost  every  human 
fabric,  subject  to  affections  which  are  tremendous  for  the 
weight  of  wretchedness  attached  to  them." 

"  Anxiety  seizes  on  some  frail  part  about  the  stomach,  and 
produces  a  specific  complaint  which  very  soon  abolishes  all 
power  of  thinking  at  all."     (1825.) 

By  1840  he  had  been  led  to  deeper  relapses  into  opium  than 
he  had  known  between  1827  and  1837.  "  His  misery  was 
great."    By  1844  he  was  taking  5,000  drops  of  laudanum  a  day. 

He  once  more  set  himself  to  subdue  the  indulgence.  "  His 
constant  careful  jottings  of  graduated  reductions  day  by  day 
— his  patient  records  of  the  effect  of  ordinary  articles  of  diet, 
his  measured  round  of  exercise,  amounting  to  15  or  20  miles  a 
day,  all  are  touching  in  the  agony  that  may  be  read  between 
the  lines."  He  reduced  the  amount  of  opium  to  six  grains  a 
day  at  one  time. 

"With  a  measured  space  of  44  yards  in  circuit,  so  that  40 
rounds  were  exactly  required  for  one  mile,  I  had,  within  90 
days,  walked  1,000  miles."     (1844.) 

"For  six  months"  (reform  as  to  laudanum  and  keeping  up 
with  the  walking)  "no  results,"  "absolute  desolation," 
"  misery  so  perfect,"  etc. 

After  eight  months  of  "  this  system "  he  recovered  "  in  a 
moment  such  a  rectification  of  the  compass  as  I  had  not  known 
for  years."  He  was  unable  to  leave  off  laudanum  altogether, 
however. 

"  He  almost  entirely  overcame  his  craving  for  opium,  and 
enjoyed  an  old  age  of  quiet  and  repose." 

De  Quincey  never  believed  his  trouble  was  due  to  opium, 
and  expressly  states  this  several  times.  For  instance :  "  Is 
there  any  key,  you  will  say,  to  its  original  cause?  Sincerely,  I 


20  BIOGRAPHIC    CLINICS. 

do  not  believe  there  is.  One  inevitable  suggestion  occurred  to 
everybody  consulted,  viz.,  that  it  might  be  some  horrible  recoil 
from  the  long  habit  of  using  opium  to  excess.  But  this  seems 
improbable  from  more  reasons  than  one,"  especially  as  before 
any  considerable  use  of  opium  he  had  had  "  an  unaccountable 
attack  of  nervous  horror,"  etc. 

In  1847  he  speaks  of  a  "  famishing,"  an  extreme  lack  of 
appetite,  or  "  incapacity  for  food,"  "  a  system  utterly  famished 
of  all  nutriment."  "  Utter  prostration  seized  me,  and  which  is 
far  worse,  utter  nervousness,"  "this  is  the  reason  I  have  not 
written,"  "I  have  been  very  ill  and  am  only  just  mending." 

In  1848  he  abstained  wholly  from  opium  for  61  days  but 
returned  to  its  "  moderate  use  "  as  the  lesser  of  two  evils. 

"I  suffer  from  a  most  afflicting  derangement  of  the  nervous 
system,  which  at  times  makes  it  difficult  for  me  to  write  at 
all."     (1850.) 

"The  ten  last  years  embrace  a  period  of  quiet  and  steady 
activity." 

"  My  father's  habits  were  simple,  almost  to  asceticism. 
From  the  neuralgic  suffering  which  led  to  his  first  taking 
opium,  he  early  lost  all  his  teeth,  and  from  the  extreme 
delicacy  of  his  system,  he  could  eat  nothing  less  capable  of 
perfect  mastication  than  bread,  so  that  only  too  often  a  little 
soup  or  coffee  was  his  whole  dinner."     (His  daughter.) 

"  Even  at  70  years  of  age  he  was  active  and  vigorous,  and 
easily  outwalked  me,  though  I  was  a  much  younger  man" 
(Hogg).  At  this  time  he  walked  nine  or  ten  miles  daily  for 
exercise. 

"  For  some  weeks  my  eyes  had  given  me  so  much  pain,  and 
consequently  so  much  anxiety  about  the  result,"  etc.  .  .  . 
"  Now "  (through  intermission,  perhaps,  of  candle-light  read- 
ing) "my  eyes  are  again  better."  (De  Quincey  in  undated 
letter,  p.  45,  Volume  II.,  Page's  "Life";  after  1850.) 

"A  nervous  malady  of  a  very  peculiar  character  which  has 
attacked  me  intermittently  for  the  last  eleven  years."  (Ibid., 
page  48.) 


THOMAS   De    QUINCEY.  21 

"  I  have  suffered  much  from  my  eyes  since  the  influenza ; 
some  days  all  but  blind,  and  on  some  nights  roused  up  for 
hours  by  the  pain,  and  still  more  by  the  nervous  uneasiness 
besieging  them.  Sulphate  of  zinc  is  all  the  remedy  I  have 
applied."     (1855.) 

"The  act  of  stooping  has  for  many  years  caused  me  so 
much  illness."  .  .  .  "The  stooping  kills  me."     (About  1856.) 

"Whether  the  fault  is  in  some  growing  defect  of  my  eyes, 
or  in  the  badness  of  such  lights  as  I  can  command,"  etc.  .  .  . 
"The  letter  cost  me  three-quarters  of  an  hour,  under  bad 
candle-light,  to  decipher."     (Perhaps  about  1859.) 

He  was  convinced  that  his  "dreaming  tendencies  were  con- 
stitutional, and  not  dependent  upon  laudanum." 

According  to  his  own  statement  (and  no  man  could  be 
more  truthful)  he  had  four  relapses  into  the  opium  habit, 
1813  to  1816,  1817  to  1818,  1824  to  1825,  and  1841  to  1844.  At 
other  times,  and  after  1844  his  use  was  "moderate,  not 
excessive." 

"  He  deliberately  records  his  conviction  in  the  latter  years  of 
his  life,  that  but  for  opium  he  would  have  been  in  his  grave 
30  years  before.  As  to  opium  in  itself  and  taken  in  due  limit, 
he  will  acknowledge  nothing  save  benefit."     (Page.) 

"  Opium  helped  to  keep  active  and  entire,  during  so  many 
long  years  of  bodily  feebleness,  that  large  and  constantly  work- 
ing brain — that  in  a  word  it  fed  it — I  have  no  manner  of 
doubt,  and  further,  that  the  almost  singular  immunity  Mr.  De 
Quincey  enjoyed  from  headache,  which  in  the  course  of  his 
long  life  he  never  knew — a  common  source  of  annoyance, 
oftentimes  of  misery,  to  ordinary-living  students — was  likely 
enough  due  to  the  opium,  I  also  believe.  (Dr.  Begbie,  who 
attended  him  in  his  last  illness.) 

"  I  generally  found  him  attempting  to  read  without  spec- 
tacles, which  he  never  employed."     (Ibid.) 

"  He  listened  with  great  interest  to  what  was  read  to  him 
from  the  morning  papers,  if  he  was  not  able  to  read  himself. 
.  .  .  When  tired  of  reading,  he  was  read  to  by,  etc.  .  .  .  Day 


22  BIOGRAPHIC    CLINICS. 

after  day  books  were  handed  in;  these,  when  unable  to  read, 
he  nevertheless  carefully  examined."     (Ibid.) 

"To  the  last  he  was  able  to  read  without  the  help  of  spec- 
tacles— one  eye  doing  all  the  work,  the  other  one  being 
invariably  closed  while  either  reading  or  writing."  (His 
daughter.) 

He  died  in  December,  1859,  in  his  seventy-fifth  year,  "his 
death  being  ascribed  rather  to  exhaustion  of  the  system  than 
to  specific  disease."  There  was  no  necropsy,  although  he 
offered  his  body  to  "  the  gentlemen  of  Surgeon's  Hall." 

He  preserved  to  the  last  his  exquisite  and  sane  humor,  his 
pathetic  sympathy  with  all  suffering  beings,  his  self-forgetful 
generosity,  his  childlike  or  childish  indifference  to  himself  and 
the  care  of  his  person,  his  almost  unrivalled  power  of  intellect 
and  of  writing  lucid  English,  and  the  graciousness  and  sweet 
urbanity  that  charmed  all  with  whom  he  spoke. 

His  picture  prefixed  to  the  Life  by  Page  is  "  from  the  por- 
trait by  Mr.  James  Archer,  R.S.A." 

There  is  an  Appendix  to  Mr.  Page's  inaccurate  and  unwork- 
manlike biography  of  De  Quincey,  entitled  "  A  Medical  View  of 
Mr.  De  Quincey's  Case"  by  Surgeon  Major  W.  C.  B.  Eatwell, 
M.D.,  F.R.S.  Dr.  Eatwell  adopts  an  old  method  of  clearing 
up  a  mystery,  viz. — explaining  a  thing  by  naming  it  with  an 
inexplainable  word.  He  is  sure  the  patient  suffered  for  a  great 
period  of  his  life  "  from  a  terrible  and  distressing  affection  of 
the  gastric  nerves  called  gastrodynia."  To  this  neuralgic 
affection  was  superadded  "  gastric  ulcer  of  the  mucous  mem- 
brane of  the  stomach,  healing  under  opium  and  the  regulation 
of  diet,  and  recurring  when  the  stomach  was  not  carefully 
managed."  Dr.  Eatwell  writes :  "  I  think  this  theory  is  borne 
out  by  the  circumstances  and  exciting  causes  attending  the 
outbreak  of  the  attack  (commencing  probably  under  the  diet 
of  hips  and  haws  in  Wales)  and  by  the  subsequent  symptoms. 
Dr.  Brinton,  in  dealing  with  the  causes  of  this  complaint, 
writes  that  the  disease  'seems  to  fall  with  disproportionate 
severity  and  frequency  on  those  who  suffer  from  the  ills  im- 


THOMAS   De    QUINCEY.  23 

plied  by  penury,  excessive  toil,  insufficient  and  unwholesome 
food,  foul  air,  mental  anxiety,  and  those  habits  of  intemper- 
ance which  are  the  effect  as  well  as  the  cause  of  such  misery/ 
The  last  of  these  agencies,"  continues  Dr.  Eatwell,  "  we  leave 
out  of  consideration ;  but  the  remaining  agents  in  the  catalogue 
of  evils  had  undoubtedly  exerted  their  full  influence  on  the 
helpless  boy,  De  Quincey." 

If  we  suppose  that,  as  stated,  these  are  the  causes  of  gas- 
tric ulcer,  then  surely  De  Quincey  had  it  not,  because,  in 
addition  to  making  an  exception  of  intemperance.  Dr.  Eatwell 
should  have  also  excepted  all  the  other  etiologic  factors 
named.  Except  for  a  little  while,  and  wholly  without  injury 
permanent  or  organic  (indeed  with  benefit),  De  Quincey  never 
was  subject  to  "penury"  or  "insufficient  and  unwholesome 
food "  and  so  far  as  "  excessive  toil,"  "  foul  air,"  and 
"  mental  anxiety  "  are  concerned,  they  never  had  much  share 
in  his  lot.  This  is  all  "  words,  words,  words."  The  theory 
of  "  gastrodynia "  plus  gastric  ulcer  is  not  of  sufficient 
strength  to  justify  refutation. 

In  1827  Carlyle,  then  32  years  of  age,  wrote  to  his 

brother  John  as  follows : 

"De  Quincey  was  here  last  Wednesday  and  sate  until  mid- 
night. He  is  one  of  the  smallest  men  you  ever  in  your  life 
beheld,  but  with  a  most  gentle  and  sensible  face,  only  that  the 
teeth  are  destroyed  by  opium,  and  the  little  bit  of  the  underlip 
projects  like  a  shelf.  He  speaks  with  a  slow,  sad,  and  soft 
voice,  in  the  politest  manner  I  have  almost  ever  witnessed  and 
with  great  gracefulness  and  sense,  were  it  not  that  he  seems 
decidedly  given  to  prosing.  Poor  little  fellow !  It  might  soften 
a  very  hard  heart  to  see  him  so  courteous,  yet  so  weak  and 
poor.  ...  He  is  an  innocent  man,  and,  as  you  said,  extremely 
washable  away" 

I  have  introduced  this  quotation  as  a  little  portrait 
and  because  of  its  diverse  illustrativeness.    In  the  first 


24  BIOGRAPHIC    CLII^ICS. 

place  it  better  testifies  than  all  of  his  other  contem- 
poraries combined  as  to  De  Quincey's  marvelous 
charm.  How  exquisite  it  must  have  been  when  he  was 
able  thus  to  soften  the  heart  of  Ursa  Major!  It  speaks 
clearly  of  the  character  of  both  men.  At  this  time  De 
Quincey,  "aged  44,  was  going  through  one  of  the  most 
critical  periods  of  his  life  and  of  his  addiction  to 
opium.  There  is  something  inexpressibly  pathetic  that 
these  great  men,  so  different  from  one  another,  yet  so 
alike,  suffering  as  I  believe  from  the  same  disease,  a 
disease  that  wrought  in  each  the  profoundest  of  trage- 
dies, and  yet,  like  uhrecognizing  brothers,  they  looked 
into  each  other's  eyes,  knowing  neither  of  the  other's 
way  and  woe. 

It  is  a  pity  and  not  a  little  strange  that  Carlyle  should 
have  fallen  into  the  stupid  error  he  did  as  regards  the 
cause  of  De  Quincey's  loss  of  teeth.  Opium  does  not 
produce  dental  caries  nor  loss  of  teeth.  De  Quincey's 
daughter  avoids  this  childish  mistake,  but  came  little 
nearer  the  truth  by  saying  that  the  loss  of  teeth  was 
due  to  the  neuralgic  suffering  which  led  to  his  first 
taking  opium.  Carlyle's  incidental  remark  is  of  value 
only  as  showing  the  opinion  of  those  with  whom  he 
talked  as  to  De  Quincey  and  thus  showing  the  hap- 
hazard manner  in  which  everything  peculiar  to  the  man 
was  ascribed  with  ridiculous  indiscrimination  to  opium. 
A  similar  misreading,  indeed,  of  his  whole  life-tragedy 
seems  to  me  perfectly  apparent  when  we  look  over  the 


THOMAS   De    QUINCEY.  25 

entire  clinical  biography  with  unprejudiced  and  philo- 
sophic minds. 

I  wish  first  to"  emphasize  that  a  careful  study  of  De 
Quincey's  mind  and  writings  brings  out  the  clearest 
conviction  that  even  about  himself  and  even  in  matters 
pathologic  (of  which  one  would  naturally  think  him 
hazy,  at  least  as  much  so  as  any  litterateur  and  layman) 
De  Quincey  never  loses  a  marvelous  sanity,  lucidity, 
and  discrimination.  The  lines  of  distinction,  reserve, 
and  consciousness — lines  that  are  not  observable  or  that 
are  faint  to  the  ordinary  eye — are  yet  most  sharply 
drawn  and  seen  by  this  subtle  beautiful  intellect.  There 
is  never  an  instant's  doubt  as  to  what  is  normal  and 
what  is  not  so,  and,  more  even  than  the  physicians  that 
attended  or  wrote  about  him,  I  would  trust  his  calm 
statements  about  these  things.  The  superciliousness  of 
the  poor  omniscients  who  affect  to  look  down  upon  that 
sublime  intelligence  and  ascribe  everything  to  "  opium, 
opium,"  is  not  to  be  weighed  against  his  own  lambent 
and  penetrating  keenness  and  rightness  of  observation. 
The  soft  gentle  manner  in  which  he  states  the  facts  as 
to  his  health  and  habits  also  heightens  the  effect  of  his 
clearness  and  accuracy  of  perception. 

We  note  then  that  his  dreamings  which  were  later 
only  intensified  and  sometimes  morbidized  by  opium, 
were  natural  to  him  and  began  before  his  drug-taking. 
He  himself  was  convinced  that  the  dreaming  tendencies 
were  constitutional.  A  dispassionate  examination  of 
3 


a6  BIOGRAPHIC    CLINICS. 

the  clinical  facts  of  his  life  compels  an  ever  increasing 
conviction  that  his  addiction  to  opium  was  never  a  cause 
of  his  physical  affliction ;  that,  except  in  the  case  of  the 
dreams  of  the  "  Confessions,"  it  was  not  the  cause  of 
his  mental  peculiarities.  The  discrimination  he  drew 
may  as  a  rule,  be  readily  accepted.  He  never  thought 
his  troubles  due  to  opium;  he  had  nervous  horror  and 
other  nervous  symptoms  before  he  took  opium,  and  the 
spasmodic  gastric,  or  rather  intestinal,  seizures  he  de- 
scribes as  beginning  in  1802,  show  that  the  ultimate 
cause  of  his  affliction  was  also  at  its  horrible  work 
before  opium-taking,  and  in  fact  that  it  led  directly  to 
the  opium  as  a  means  of  relief.  I  think  that  it  is  liter- 
ally true,  as  De  Quincey  thoroughly  believed,  that 
opium  saved  his  life,  enabled  him  to  live  and  work,  pre- 
vented his  death  at  middle  age,  and  on  the  whole,  and 
when  "  taken  in  due  limit "  was  of  benefit  to  him. 
That,  of  course,  is  far  from  justifying  its  use  by  others 
and  at  the  present  time,  and  equally  as  far  from  admit- 
ting that  a  true  cure  does  not  exist  for  De  Quincey's 
trouble,  and  for  that  of  others  due  to  the  same 
cause. 

The  strange  fatalism  and  impenetrable  mystery  of 
the  true  nature  and  source  of  his  misery,  was  of  course 
present  to  his  own  mind,  but  it  was  a  problem  too  near 
at  hand,  too  astonishingly  near,  to  be  even  suspected. 
He  stands  before  the  Sphinx  and  asks :  "  Is  there  any 
key  to  its  original  cause?    Sincerely  I  do  not  believe 


THOMAS   De    QUINCEY.  27 

there  is."     "  One  inevitable  suggestion,"  etc.,  did  not 
explain,  was  in  fact,  based  upon  error. 

Something  more  than  the  unrivalled  intellect  stares 
at  one  in  the  fact  that  the  14-year-old  boy  v^as  the  best 
classical  linguist  in  Europe,  and  that  at  the  same  time 
he  was  reading  so  omnivorously  that  he  would  sacrifice 
his  allowance  and  go  in  debt  for  books.  One's  astonish- 
ment grows  to  the  greatest  marvelling  when  he  finds 
that  this  lad  was  also  an  energetic  and  boyish  fellow, 
most  fond  of  outdoor  life  and  activity.  But  now  begin 
the  silent  palsying  blows  of  an  unseen  and  most  mys- 
terious fate.  The  boy  of  14  or  15  has  to  be  taken  from 
school  "  in  consequence  of  a  very  alarming  illness 
threatening  his  head."  This  lasted  for  more  than  a 
year,  and  was  followed  by  a  return  of  good  spirits, 
though  he  continued  to  suffer  much  at  intervals  from 
headache.  Again  he  was  put  to  school,  but  three- 
fourths  of  the  time  he  is  out  of  health,  not  seriously 
ill,  but  worse,  weary,  torpid  and  languid.  About  this 
time  begin  the  gastric  "  twitchings,  the  loss  of  sleep,  and 
the  increasing  weakness."  Finally,  his  sufferings  and 
the  lack  of  exercise,  etc.,  could  not  longer  be  endured, 
and  he  breaks  into  absolute  revolution,  and  at  the  age  of 
17  he  borrows  money,  runs  away  to  Wales,  and  lives  a 
wanderer's  life  among  the  farmers  and  on  the  hills. 
His  health  gains,  but  his  money  does  not,  and  he  goes 
to  London,  where  for  a  short  time  he  finds  out  what 
real  poverty  means.     Its  power  of  logic  probably  de- 


2  8  BIOGRAPHIC    CLINICS. 

cided  him  to  accept  advice  and  to  try  study  once 
more. 

The  tremendous  influence  of  eye-strain  upon  disposi- 
tion, character,  and  vocation,  was  borne  in  upon  me  the 
first  year  I  was  in  practice.^  Almost  every  day  since  then 
the  truth  has  become  more  striking  and  evident.  Chil- 
dren's lives  and  minds  are  unconsciously  and  constantly 
modified,  always  unnaturally  and  morbidly,  because  of 
the  fact,  unconscious  to  them,  that  reading  and  study 
and  writing  irritates  and  disorders  the  central  nervous 
system,  the  digestional  organs,  etc.  De  Quincey  could 
not  escape  his  fate,  but  others  do — and  meet  another, 
however!  Every  child's  eyes  should  be  periodically 
examined,  under  mydriasis,  by  an  expert  refrac- 
tionist. 

Much  against  his  will  young  De  Quincey  consented 
to  try  to  study  once  more,  this  time  in  Oxford.  In  his 
second  year  (1804)  his  severe  neuralgic  affection  led 
him  to  try  opium  for  the  first  time.  With  a  less  well- 
balanced  mind  than  that  of  De  Quincey,  and  especially 
if  we  remember  his  intense  suffering,  this  method  of 
treatment  would  at  once  have  been  equivalent  to 
"  throwing  the  baby  away  with  the  bath,"  but  with  De 
Quincey,  although  it  at  once  gave  a  heavenly  relief,  he 
became   only   an    occasional    rather   than    a   constant 

^ "  The  Psychological  Influence  of  Errors  of  Refraction  and 
of  their  Correction,"  Medical  and  Surgical  Reporter,  Septem- 
ber 29,  1888. 


THOMAS   De    QUINCEY.  29 

devotee  of  the  drug  for  nine  years.  His  love  of 
roaming  over  the  hills  and  valleys  was  kept  up  at 
Oxford,  but  despite  this,  and  also  notwithstanding  the 
opium,  w^hich  indeed  masked  and  relieved  but  could  not 
cure  the  symptoms,  least  of  all  their  cause,  he  again 
could  not  endure  systematic  and  continuous  study — he, 
par  excellence,  a  born  student  and  lover  of  books  and 
study !  He  soon  left  Oxford  and  spent  several  years  in 
objectless  travel  or  wandering  about,  settling  at  last 
in  1809,  aged  24,  at  Grasmere.  Here  were  kept  up 
the  constant  exercise,  the  long  walks,  the  interest  in 
sport,  and  the  seemingly  morbid  solitary  walks  in  the 
darkness  of  the  night.  Despite  these  things,  in  18 12 
there  was  a  suddenly  appearing  and  as  suddenly  dis- 
appearing five  months'  attack  of  "  nervous  horror  "  and 
in  1813  such  an  increased  intensity  of  the  "irritation 
of  the  stomach  "  that  for  relief  he  increased  the  inter- 
mittent doses  of  opium  he  had  been  taking  since  1804, 
until  he  was  soon  taking  as  much  as  340  grains  a  day. 
He  would  not  marry  while  taking  so  much,  and  by  18 16 
he  had  so  far  conquered  the  habit  that  he  felt  justified 
in  marrying.  This  period  of  1813-1816  was  his  first 
one  of  excess,  but  immediately  after  marriage  his  suf- 
fering became  more  unendurable  and  for  a  year  he 
relapsed.  His  heroism  in  1821  in  again  fighting  and 
winning  the  battle  was  only  rewarded  by  great  suffer- 
ing, dejection,  "  derangement  of  the  liver,"  etc.,  and 
there  followed  another  relapse  into  excess  from  1824 


30  BIOGRAPHIC    CLINICS. 

to  1825.  The  last  relapse  was  from  1841  to  1844.  At 
other  times  and  after  this  time  there  was  moderate,  not 
excessive  use. 

This  history  of  his  splendid  struggle  and  success  in 
1844,  his  absolute  abstention  for  61  days  in  1848,  and 
his  wise  choice  thereafter  of  moderate  use  as  the  lesser 
of  two  evils,  his  ten  last  years  of  life  in  "  quiet  and 
steady  activity,"  are  also  noteworthy. 

There  are  two  factors  that  should  not  be  lost  from 
view :  The  first  relates  to  the  fact  that  a  man  so 
destined  by  nature  and  profession  to  the  life  of  a 
scholar  and  writer  as  was  De  Quincey,  must  devote 
a  certain  portion  of  his  time,  of  each  day  usually,  to 
reading,  writing,  and  revising  proof-sheets.  The 
second  is  closely  related  to  it — mathematically  so,  one 
might  say,  as  well  as  logically — and  concerns  the  mat- 
ter of  physical  exercise.  No  one  who  has  studied  the 
life  of  De  Quincey  (or  the  lives  of  the  other  men  whom 
we  are  to  observe  later)  seems  to  have  adequately  pon- 
dered, at  least  not  to  have  asked  for  the  significance  ofy 
the  irresistible  necessity  these  men  were  under  to  walk 
or  exercise.  Ocular  accommodative  effort  and  reflexes 
cease  in  walking  almost  entirely,  and  absolutely  so  in 
walking  at  night.  All  his  life  De  Quincey  walked 
many  miles  a  day,  walked  in  day  and  darkness,  in  sun- 
shine or  in  rain,  and  in  the  worst  time  of  trials  he  would 
walk  round  and  round  a  ring,  like  a  poor,  dumb,  driven 
animal,  40  rounds  to  the  mile,  from  400  to  500  times  a 


THOMAS   De    QUINCEY.  $1 

day.    At  the  age  of  70  he  was  still  active  and  vigor- 
ous, outwalking  younger  men. 

Another  clear  indication  of  the  ultimate  cause  of  De 
Quincey's  affliction  is  given  by  noticing  the  dates  of  the 
relapses  into  opium-addiction.  The  first  two  are  prac- 
tically one,  extending  from  1813  to  181 8,  the  second, 
1824  to  1825,  the  third  1 841  to  1844.  Observant 
ophthalmologists  know  that  in  the  life  history  of 
patients  suffering  from  uncorrected  eye-strain,  or 
optical  error,  there  tends  to  be  three  critical  periods  or 
crises.  In  girls  and  women  these  crises  are  of  some- 
what different  ordering.  Here  I  speak  only  of  boys 
and  men,  and  in  them  the  first  is  at  or  within  a  few 
years  of  puberty.  The  second  is  in  early  adult  life,  the 
third  comprises  the  period  of  the  failure  of  accommoda- 
tion extending  normally  from  about  45  to  60,  but  vary- 
ing according  to  the  amount  and  kind  of  ametropia.  In 
hyperopic  or  "  far-sighted  "  astigmatism  it  begins  five 
or  even  ten  years  earlier.  In  De  Quincey's  case  the 
first  crisis  came  at  the  logical  age  of  14,  when  he  had  to 
be  taken  from  school  because  of  the  "  very  alarming 
illness  threatening  his  head."  Every  ocuHst  knows 
well  enough  about  these  ocular  or  ametropic  head- 
aches. They  more  seldom  occur  in  boys  and  men  than 
in  girls  and  women.  The  reflex  of  eye-strain  in  the 
latter  is  usually  to  the  head,  with  more  or  less  implica- 
tion of  the  digestional  organs.  In  boys  the  tendency  is 
to  the   eyes    (styes,   blepharitis,   conjunctivitis,   etc.), 


32  BIOGRAPHIC    CLINICS. 

while  ill  men,  especially  in  severe  eye-workers,  it  is 
usually  to  the  digestional  organs  alone.  But  there  are 
many  cases  of  modified  or  masked  symptoms,  depend- 
ing upon  the  always  varying  conditions  of  the  eyes, 
native  vigor,  external  circumstances,  etc.  The  note- 
worthy fact  is  the  long-continued  increased  intensity  of 
all  reflexes  during  the  failure  of  accommodation,  and  the 
sudden  cessation  of  direct  ocular  reflexes  at  about  60.  If 
the  long-continued  functional  diseases  of  the  digestional 
and  cerebral  centers  have  at  that  time  not  been  too 
badly  injured,  there  is  peace  for  the  rest  of  life.  But 
if  irreparable  harm  has  been  done  them,  symptoms  will 
be  changed  but  will  persist.  Of  course,  according  to 
circumstances  and  conditions  one  period  may  extend 
into  another,  and  the  habit  of  drug-taking  or  the  hap- 
hazard catching  up  of  a  pair  of  spectacles  may  modify 
but  not  abrogate  the  symptoms.  In  De  Quincey's  case 
the  first  critical  period  (head  pains),  plainly  due  to 
eye-strain,  passed  off  in  a  year,  but  recurred  in  one 
form  or  another  until  he  was  compelled  to  run  away 
from  school  and  seek  rest  from  eye-strain  even  by 
vagabondage  if  necessary,  at  all  events  by  the  walking 
or  exercise  which  all  such  sufferers  are  unconsciously 
compelled  to  undertake.  Of  course,  one  so  endowed  as 
De  Quincey  could  not  escape  the  literary  life,  and  his 
compromise  with  the  unknown  enemy  that  possessed 
him  was  opium  and  walking.  The  first  hid  and  modi- 
fied the  results   of  eye-strain,   the   second   gave  the 


THOMAS   De   QUINCEY.  33 

health  to  resist,  and  the  eye-rest  demanded  for  recuper- 
ation. 

In  all  severe  eye-strain,  insomnia,  apparently  due  to  a 
number  of  mysterious  causes,  is  almost  always  a  con- 
stant symptom.  ("  Kicks  about  at  night  and  cries  out 
in  his  sleep  "  is  an  almost  invariable  report  of  parents 
in  astigmatic  children.)  How  it  affected  De  Quincey 
may  be  seen  throughout  the  biography.  At  the  age  of 
28  the  "  stomach  and  liver  symptoms  "  became  greatly 
intensified  and  the  doses  of  opium  became  enormous. 
Love  and  marriage  nerved  him  to  moderation  for  a 
year  or  two,  but  continued  and  increased  eye-work 
drove  him  again  to  his  enemy-friend.  During  the  two 
years  of  his  greatest  ocular  labor  in  middle  life  all  his 
great  strength  of  will  to  renounce  opium  entirely  was 
in  vain  and  indeed  unwise.  Even  physicians  are  per- 
haps in  this  and  similar  cases  too  apt  to  forget  the 
established  clinical  fact  that  the  greater  the  pain  and 
inflammation  the  higher  the  dose  of  the  anodyne  re- 
quired. For  example,  in  peritonitis  doses  of  morphin 
may  be,  must  be,  given,  a  very  small  part  of  which 
would  kill  if  the  patient  was  in  a  normal  condition. 
In  De  Quincey's  case  the  anodyne  in  large  doses  was 
necessary  to  give  him  relief  from  the  "  misery," 
*'  gnawing,"  ''  the  horrors,"  the  "  specific  complaint," 
the  "  twitching,"  the  ''  depression,"  etc.,  from  which 
he  suffered  whenever  he  discontinued  the  drug. 
Notice  that  only  at  62  was  he  able  to  discontinue  it 


34  BIOGRAPHIC    CLINICS. 

entirely,  but  in  two  months  found  it  wiser  to  continue 
its  moderate  use  for  the  rest  of  his  life.  Notice  also 
again  that  these  last  years  were  years  of  "  quiet  and 
steady  activity." 

Without  a  scrap  of  direct  evidence  as  to  the  exist- 
ence of  eye-strain,  a  study  of  the  clinical  biography  of 
De  Quincey  by  a  competent  oculist  should  con- 
vince him  that  the  mystery  of  De  Quincey's  life 
and  disease,  "  the  key  to  the  original  cause,"  as 
he  puts  it,  of  his  suffering,  was  reflex  ocular  neur- 
osis. Why  then  did  his  eyes  not  pain  him  and 
suffer?  It  is  one  of  the  greatest  of  unutilized  truths, 
long  known,  strangely  ignored,  that  in  the  vast 
majority  of  cases  of  eye-strain  the  morbid  results  of  the 
astigmatism,  etc.,  are  not  felt  in  the  eyes.  It  is  per- 
fectly explainable  why  this  is  so.  The  value  of  the 
eye  so  overtops  that  of  almost  any  other  organ  that 
the  reflex  results  of  its  unphysiologic  function  must  be 
shunted  anywhere  except  back  to  the  eye  itself.  In 
women  it  goes  to  the  head,  and  the  world  is  full  of 
those  tortured  nearly  every  day  of  their  life  with  head- 
ache and  sick-headache  ("  biHous  "  or  "  nervous  " 
headaches).  In  many,  and  especially  in  men  working 
much  with  the  eyes,  the  reflex  is  to  the  digestional 
organs,  with  "  indigestion  "  and  "  liver  derangements," 
"  anorexia,"  etc.  The  truth  that  eye-strain  induces 
these  functional  gastric,  intestinal,  and  biliary  disorders 
cannot  much  longer  be  ignored.    When  acted  upon  it 


THOMAS   De    QUINCEY.  35 

will  constitute  one  of  the  greatest  advances  in  practical 
medicine  that  has  ever  been  made.  In  the  meantime 
the  supercilious  indifference  and  ignoring  of  the  fact 
is  one  of  the  awful  expenses  of  life  and  an  opprobrium 
of  medicine. 

We  must  not  forget  that  in  the  days  of  De  Quincey, 
Carlyle,  etc.,  candles  and  rush-lights  were  the  common 
sources  of  artificial  light.  When  even  our  wonderful 
best  modern  lights  are  by  no  means  equal  to  daylight, 
and  are  found  taxing  to  weak  and  defective  eyes,  what 
must  have  been  the  degree  of  eye-strain  in  the  days  of 
candles  ? 

At  about  65  De  Quincey's  eyes  began  troubling  him. 
When  accommodation  had  been  entirely  lost,  the  morbid 
reflex  could  not  be  shunted  elsewhere,  and  must  be 
returned  to  the  eyes  themselves.  He  had  "  pain," 
which  means,  beyond  question,  inflammation  of  the  ex- 
ternal or  visible  parts  of  the  eye.  (Cataract  and  retinal 
inflammations  are  painless.)  Stopping  reading  by 
candle-light  naturally  relieved  him.  It  returned  worse 
than  ever  and  affected  the  cornea  ("all  but  blind") 
and  sulphate  of  zinc  was  the  excellent  remedy  used. 
This  conjunctival  trouble  continued  to  the  end  of  his 
life,  and  in  the  last  years  most  of  the  reading  was  done 
for  him  by  others,  reading  aloud. 

As  I  have  said,  the  trained  oculist  would  not  need 
direct  evidence  of  ametropia,  etc.,  to  convince  him  of 
the  subtle  source  of  De  Quincey's  affliction.     But  as 


36  BIOGRAPHIC    CLINICS. 

such  positive  evidence  would  aid  in  bringing  convic- 
tion to  the  layman  and  to  the  ultra-conservative  physi- 
cian, he  would  welcome  any  such  demonstration  of 
the  optical  abnormality  of  this  patient's  eyes.  Luckily 
it  exists,  and  in  a  duplicate  and  mutually  corroborative 
form.  The  first  is  the  picture  (reproduced  herewith) 
of  De  Quincey,  prefixed  to  the  "  Life  and  Letters  " 
(by  Page),  made  from  the  portrait  by  Mr.  James 
Archer,  R.S.A.  In  this,  as  any  ophthalmologist,  or 
even  any  observant  layman,  can  see,  the  eyes  are  diver- 
gent. In  sitting  for  a  portrait  in  which  the  eyes  are 
not  directed  ("  centered ")  upon  the  spectator,  they 
naturally  fall  into  a  position  of  noninnervation,  de- 
scribed as  "  at  rest,"  "  fixed  upon  vacancy,"  or  "  look- 
ing at  an  infinite  distance."  When  the  external  ocular 
muscles  are  balanced  ("  orthophoria,"  "  parallelism," 
etc.),  the  axes  unite  at  a  far  point  such  as  a  star,  the 
horizon,  or  at  twenty  feet  distance.  When  there  is 
imbalance  of  the  muscles  ("  heterophoria,"  "squint," 
"  strabismus  ")  there  is  no  such  uniting  of  the  axes  in 
a  state  of  rest  or  noninnervation.  Naturally  in  sitting 
for  the  painter  De  Quincey's  eyes  took  this  position — 
literally  one  of  rest,  and  it  speaks  much  for  the  paint- 
er's fine  ability  that  he  painted  the  truth  as  he  found  it. 
That  truth  was  that  De  Quincey  had  what  the  Amer- 
ican oculist  calls  "  exophoria,"  and  the  European 
names  "insufficiency  of  the  interni."  It  is  not  squint  or 
strabismus,  at  least  not  permanently  that,  but  so  far 


THOMAS   De   QUINCEY.  37 

as  symptoms  go  it  is  infinitely  worse  than  permanent 
divergence.  The  eyes,  or  one  eye,  is  not  always  diver- 
gent, or  turned  out,  but  only  when  attention  and 
"  fixation  "  are  not  aroused.  Then,  as  in  the  portrait, 
it  is  manifest.  At  other  times  the  eyes  appear,  and  are, 
normally  "  fixing."  That  De  Quincey  had  not  diver- 
gent strabismus  is  all  but  certain,  because  many — at 
least  Carlyle ! — would  have  described  the  striking  fact. 
Naturally  none  but  the  painter  would  record  the  fact 
of  the  divergence  of  the  eyes  at  rest. 

Our  own  attention  is  interestedly  fixed,  also,  by  a 
perfect  bit  of  corroborative  testimony — the  statement 
that  De  Quincey  in  his  later  years  used  but  one  eye 
when  reading  and  writing,  the  other  "  being  invariably 
closed."  If  this  unused  eye  had  been  always  or  per- 
manently divergent  it  would  not  have  been  closed, 
because  it  would  have  been  blind,  amblyopic,  or  its 
visual  activity  psychically  ignored  (as  all  oculists 
understand)  so  that  there  would  have  been  no  need 
of  shutting  it  out  by  the  closed  lid.  Fixation  in  "  near 
work  "  with  it  was  in  the  late  years  so  tiresome  that 
nature  must  allow  it  to  diverge.  That  this  eye  had  fair 
vision  is  shown  by  the  fact  that  the  conflicting  double 
image  (in  divergence)  had  to  be  extinguished  by 
closing  the  lid.  That  this  closing  of  one  eye  in  read- 
ing and  writing  was  adopted  late  in  life  is  demon- 
strated by  the  two  facts,  that  it  was  not  ambly- 
opic   (required  lid  closure),  and  that  there  was  no 


38  BIOGRAPHIC    CLINICS. 

permanent  "  ptosis,"  or  paralytic  closing  of  the  lid. 
Even  to  his  death  both  eyes  were  "  open  "  when  look- 
ing at  any  person,  or  at  a  distance.  When  looking  at  a 
book,  etc.,  after  accommodation  failed,  there  could  not 
be  the  double  convergence  required  except  by  a  strain- 
ing effort  greater  than  that  required  to  hold  one  lid 
closed. 

A  capital  proof  of  all  this,  moreover,  is  offered  to  us 
in  the  statements  of  his  daughter  and  of  his  physician 
that  even  at  74  he  never  used  spectacles  for  reading. 
We  now  know  that  even  with  the  best  application  no 
spectacles  that  any  person  could  have  obtained  at  that 
time  would  have  completely  relieved  eye-strain.  Oph- 
thalfnology  at  that  time  had  not  risen  to  its  splendid 
opportunity.  It  has  only  done  so  exceptionally  to-day. 
To  its  disgrace  operations  and  inflammatory  diseases 
still  occupy  the  specialist's  attention  too  exclusively. 
Spectacles  of  the  crudest  kind  were  discovered  only 
about  500  years  ago  and  science  and  some  scientific 
men  seem  often  inclined  to  ignore  for  another  500 
years  their  use  and  improvement  in  correcting  the 
optical  defects  of  the  eye  that  looks  through  their 
infinitely  studied  and  perfected  microscopes.  But  all 
the  lenses  of  all  the  opticians  of  that  country  and  time 
would  not  have  helped  poor  De  Quincey.  Why?  Be- 
cause he  had  myopic  astigmatism,  and  of  some  anom- 
alous and  anisometropic  variety.  Had  he  not  been 
afflicted  with  this  optical  fault  of  his  eyes,  he  could 


THOMAS   De    QUINCEY.  39 

not  have  read  a  line  of  any  book  at  the  age  of  70.  It 
should  also  be  noted  that  the  opium  he  took  would  pro- 
duce myosis,  or  narrowing  of  the  pupil  to  a  "  pin 
point "  diameter.  This  would  also  greatly  aid  him  in 
shutting  out  the  confusing  rays  or  diffusion  circles, 
caused  by  astigmatism,  and  would  thus,  in  a  way, 
make  his  vision  better.  Unconsciously  this  fact  may 
also  have  aided  in  the  addiction  to  the  opium-habit 
itself.  Up  to  the  age  of  about  62  he  was  able  to  pre- 
serve binocular  vision,  but  at  an  expense  to  his  nervous 
and  digestional  system  which  was  essentially  the  cause 
of  his  opium  habit,  and  of  all  his  suffering.^  At  any 
time  of  his  life  a  proper  pair  of  spectacle  lenses  would 
have  relieved  De  Quincey  of  his  sufferings,  would  have 
enabled  him  to  quit  opium-taking,  and  would  have 
allowed  him  to  pursue  a  far  more  wonderful  literary 
career. 

Even  with  De  Quincey's  incomparable  brilliancy  and 
accuracy  of  insight  he  could  not  have  divined  all  this. 
How  near  to  it  he  came,  however,  is  to  be  found  in  a 
number  of  selections  from  his  writings.  If  he  could 
have  suspected  that  the  source  of  the  disorders  of  "  the 
whole  process  and  elaborate  machinery  of  digestion  " 
in  his  case  was  in  that  most  delicate,  important,  and 
wonderful  organ  of  vision,  he  would  probably  have 

^  Dr.  Begbie  thinks  De  Quincey's  immunity  from  headache 
was  due  to  the  opium.  He  did  not  know  that  myopic  patients 
do  not  have  headache. 


40  BIOGRAPHIC    CLINICS. 

made  the  following  passage  even  more  beautifully 
powerful  and  pathetic  than  it  is :  "  The  whole  process 
and  elaborate  machinery  of  digestion  are  felt  to  be 
mean  and  humiliating,  when  viewed  in  relation  to  our 
mere  animal  economy.  But  they  rise  into  dignity,  and 
assert  their  own  supreme  importance,  when  they  are 
studied  from  another  station,  viz.,  in  relation  to  the 
intellect  and  temper.  No  man  dares  then  to  despise 
them.  It  is  then  seen  that  these  functions  of  the 
human  system  form  the  essential  basis  upon  which  the 
strength  and  health  of  our  higher  nature  repose,  and 
that  upon  these  functions  chiefly,  the  genial  happiness 
of  life  is  dependent.  All  the  rules  of  prudence,  or  gifts 
of  experience  that  life  can  accumulate,  will  never  do  as 
much  for  human  comfort  and  welfare  as  would  be 
done  by  a  stricter  attention,  and  a  wiser  science, 
directed  to  the  digestive  system." 


CARLYLE. 


4« 


CHAPTER  II. 
THOMAS    CARLYLE. 

The  formidable  number  of  the  following  excerpts 
should  not  deter  the  reader,  if  at  all  interested  in  the 
subject,  from  attentive  consideration  of  each.  I  have 
omitted  a  hundred  or  more  which  were  merely  general 
expressions,  or  repetitions  of  these,  in  order  to  reduce 
the  space  as  much  as  possible.  But,  for  one  reason  or 
another,  I  think  every  line  quoted  has  some  special 
significance  in  helping  to  give  a  thorough  understand- 
ing of  the  clinical  biography  of  the  patient : 

Thomas  Carlyle  was  bom  December  4,  1795. 

At  the  age  of  23,  says  Froude,  "  he  was  attacked  with  dyspep- 
sia, which  never  wholly  left  him,  and  in  these  early  years 
soon  assumed  its  most  torturing  form,  'like  a  rat  gnawing  at 
the  pit  of  his  stomach.' "  At  this  time  he  says  of  himself, 
just  entering  upon  "the  three  most  miserable  years  ot  his  life," 
he  was  fast  losing  his  health  (while  a  student  in  Edinburgh), 
"a  prey  to  nameless  struggles  and  miseries,  which  have  yet  a 
kind  of  horror  in  them  to  my  thoughts,  three  weeks  without 
any  kind  of  sleep,  from  impossibility  to  be  free  from  noise." 

"  In  sickness  of  body  and  mind,"  "  dyspepsia  had  him  by  the 
throat,"  "irritable,"  "gey  ill  to  live  wi ',"  etc.,  are  further 
descriptions  of  these  years, 

"I  enjoyed  any  amount  of  walking  in  those  young  years." 

"Bad  health  does  depress  and  undermine  one  more  than 
all  other  calamities  put  together."     (24  years  of  age.) 

43 


44  BIOGRAPHIC    CLINICS. 

"  With  stupidity  and  sound  digestion  man  may  front  much." 
(25.) 

"  It  is  these  *  coorsed  nervous  disorders.'  If  I  had  but 
strong  health !"     (26.) 

"  In  spite  of  all  my  dyspepsias,  and  nervousness  and  hypo- 
chondrias."    (27.) 

"  He  had  been  working  hard  on  Schiller  and  Meister.  He 
had  been  complaining  of  his  health  again."     (28.) 

"  Is  Tom  got  better  ?  Does  he  sleep  well  yet  ?  It  gaed  to  my 
heart  when  he  told  me  in  the  last  letter  that  he  couldna  sleep 
without  his  finger  in  his  ear."     (His  father.) 

"  I  sleep  irregularly  here,  and  feel  a  little,  very  little,  more 
than  my  usual  share  of  torture  every  day.  What  the  cause  is 
would  puzzzle  me  to  explain.  I  take  exercise  sufficient  daily; 
I  attend  with  rigorous  minuteness  to  the  quality  of  my  food ;  I 
take  all  the  precautions  that  I  can,  yet  still  the  disease  abates 
not."     (28.) 

"  Wrecked  with  want  of  sleep." 

"Ill-health,  the  most  terrific  of  all  miseries." 

"  A  state  of  health  worse  than  ever  it  was." 

"I  was  consulting  doctors  who  made  me  give  up  my  dear 
nicotine,  and  take  to  mercury." 

"  Grown  sicker  and  sicker.  ...  I  want  health,  health, 
health.  On  this  subject  I  am  becoming  quite  furious.  ...  If 
I  do  not  soon  recover,  I  am  miserable  forever  and  ever.  They 
talk  of  the  benefit  of  ill-health  from  a  moral  point  of  view. 
I  declare  solemnly,  without  exaggeration,  that  I  impute  nine- 
tenths  of  my  present  wretchedness,  and  rather  more  than  nine- 
tenths  of  all  my  faults,  to  this  infernal  disorder  in  the 
stomach."     (Aged  28,  at  work  on  Meister.) 

"  These  drugs  leave  me  scarcely  the  consciousness  of  exist- 
ence. .  .  .  There  is  mercurial  powder  in  me,  and  a  gnawing 
pain  over  all  the  organs  of  digestion,  especially  in  the  pit  and 
left  side  of  the  stomach."     (Ibid.) 

"  Stupid,  unhappy,  by  fits  wretched,  but  also  dull— dull  and 
very  weak."     (Ibid.) 


THOMAS    CARLYLfi.  4S 

"*A  long  ^airy-eared  jackass/  as  he  called  some  eminent 
Edinburgh  physician,  had  ordered  him  to  give  up  tobacco, 
but  he  had  ordered  him  to  take  mercury  as  well;  and  he  told 
me  that  along  with  the  mercury  he  must  have  swallowed 
whole  hogsheads  of  castor  oil."     (Ibid.) 

"  On  days  when  moderately  well,  I  feel  as  happy  as  others ; 
happier,  perhaps." 

"...  A  Mr.  Badams,  a  graduate  in  medicine,  though  his 
business  is  in  chemical  manufactures  in  Birmingham,  .  .  . 
is  one  of  the  most  sensible,  clear-headed  persons  I  have  ever 
met  with.  .  .  .  After  going  about  for  a  day  or  two  talking 
about  pictures  and  stomach  disorders,  in  the  cure  of  which  he 
is  famous,  and  from  which  he  once  suffered  four  years  in 
person,  what  does  the  man  do  but  propose  that  I  should  go  up 
to  Birmingham  for  a  month  and  live  with  him  that  he  might 
find  out  the  make  of  me,  and  prescribe  for  my  unfortunate 
inner  man.  I  have  consented.  ...  Of  his  skill  in  medicine 
I  augur  favorably  from  his  general  talent,  and  from  the  utter 
contempt  in  which  he  holds  all  sorts  of  drugs  as  applied  to 
persons  in  my  situation.  Regimen  and  exercises  are  his 
specifics,  assisted  by  as  little  gentlest  medicine  as  possible.  On 
the  whole,  I  think  I  never  had  such  a  chance  for  the  recovery 
of  health.  ...  I  am  going  to  take  books  and  read,"  etc.     (28.) 

Eight  weeks  with  Badams  brought  no  relief.  "The  con- 
tempt of  drugs  which  Badams  had  professed  in  London  had 
been  rather  theoretic  than  practical,"  says  Froude.  Carlyle 
puts  it  thus :  "  I  have  been  bephysicked  and  bedrugged.  I 
have  swallowed  about  two  stoupfuls  of  castor  oil  since  I  came 
hither;  unless  I  dose  myself  with  that  oil  of  sorrow  I  cannot 
get  along  at  all."  Badams  wished  him  to  come  back  "  for 
another  month  until  he  had  completed  his  doctorial  and  castor 
oil  system  with  me.  Some  of  Badams'  drugs  had  not  pros- 
pered with  me,  and  I  fell  below  par  in  point  of  health."     (29.) 

Badams  himself  took  to  drink,  as  described  by  Carlyle  six 
years  later,  "  for  the  sake  of  an  intolerable  headache  which 
brandy  was  wont  to  cure/'  and  soon  "  died  miserably." 


46  BIOGRAPHIC    CLINICS. 

The  complaints  of  "bad  stomach,"  "bad  health,"  etc.,  now 
became  frequent  and  bitter,  and  the  passionate  resolves  to  get 
health  most  pathetic. 

"  Could  I  live  without  taking  drugs  for  three  months,  I 
should  even  now  be  perfectly  well."     (29.) 

Upon  his  farm  at  Hoddam  Hill  he  improves.  "Long  soli- 
tary rides  on  my  wild  Irish  horse  Larry,  good  for  the  dietetic 
part,"  He  steadily  gains  in  health,  "and  for  my  occupations 
{i.  e.,  literary  work)  they  amount  to  zero."  "It  is  rather  a 
holy  time,  a  pax  Dei  which  exhausted  Nature  has  conquered 
for  herself."     (29.) 

He  threw  himself  into  a  course  of  wide  and  miscellaneous 
reading,  and  at  the  time  of  his  recent  marriage  and  settlement 
in  London,  he  asks,  "  Why  am  I  not  happy  then  ?  Alas,  Jack, 
I  am  bilious.  I  have  to  swallow  salts  and  oil ;  the  physic  leaves 
me  pensive  yet  quiet  in  heart,  and  on  the  whole  happy  enough ; 
but  the  next  day  comes  a  burning  stomach  and  a  heart  full  of 
bitterness  and  gloom."     (31.) 

"  Sick  with  sleeplessness,  nervous,  bilious,  splenetic,  and  all 
the  rest  of  it."     {Ibid.) 

"Beggarly  want  of  hope."     {Ibid.) 

"  It  is  strange  how  one  gets  habituated  to  sickness."    {Ibid.) 

"  The  new  book  is  going  at  a  regular  rate.  .  .  .  Oh,  that  he 
were  indeed  well."     (Mrs.  Carlyle.) 

"  I  fight  with  dullness  and  bile  in  the  forenoons  as  of  old." 
(He  worked  in  the  forenoon  and  "walked  diligently"  in  the 
afternoon.) 

"  I  have  been  in  considerably  better  health  ever  since  I  came 
to  Craigenputtock  and  found  my  red  chestnut  Irish  doctor 
saddled,  waiting  for  me  in  his  stall."     (33.) 

"  None  can  say  how  bilious  I  am,  and  am  like  to  be ;  but  I 
have  begun  to  ride  daily  on  Larry,  and  so  Jeffrey  shall  have 
his  article  at  the  appointed  time."     (33.) 

"  He  went  out  in  all  weathers,  indifferent  to  wet,  and  in 
spite  of  his  imagined  ill-health,  impervious  to  cold."    (Froude.) 

"  You  cannot  figure  the  stillness  of  these  moors  in  November 


THOMAS    CARLYLE.  47 

drizzle.    Nevertheless  I  walk  often  under  cloud  of  night,  down 
as  far  as  Carstammon  Bum,  sometimes  to  Sandy  Wells,"  etc. 

(33.) 

"  He  took  his  nightly  walks  on  the  frozen  moor."    (Froude.) 

"  Farthing  rushlights  for  illumination  after  dark."  (At 
Craigenputtock,  aged  36.) 

"  Mrs.  Carlyle's  faith  in  physicians  is  somewhat  on  a  level 
with  my  own;  that  she  will  give  them  no  more  of  her  blood, 
but  trust  to  exercise,  diet,  and  the  return  of  settled  weather." 
(36.) 

"His  health  was  essentially  robust."     (Froude.) 

"  My  husband  is  as  good  company  as  reasonable  mortal  could 
desire.  Every  fair  morning  we  ride  on  horseback  for  an  hour 
before  breakfast."     (Mrs.  Carlyle.) 

"I  am  better  resting.  I  had  made  myself  bilious  enough 
with  my  writing,  and  had  need  to  recover  as  I  am  doing.  (At 
Edinburgh,  aged  38.) 

"Her  complaint  (Mrs.  Carlyle)  seems  like  mine,  a  kind  of 
deep-seated  dyspepsia ;  no  medicine  is  of  avail,  only  regimen 
(when  once  one  can  find  it  out)  free  air  and,  if  that  is  possible, 
cheerfulness  of  mind."     {Ihid.) 

"  I,  when  I  take  walking  enough,  get  along  as  I  was  wont 
in  that  particular.  Continued  sickness  is  a  miserable  thing, 
yet  one  learns  to  brave  it."     (39.) 

"The  world  is  God's  world,  and  wide  and  fair."     (Ibid.) 

"The  history  of  the  French  Revolution,  the  most  powerful 
of  all  his  works,  and  the  only  one  which  has  the  character  of 
a  work  of  art,  was  the  production  of  the  mind  which  he 
brought  with  him  from  Craigenputtock,  undisturbed  by  the 
contradictions  and  excitements  of  London  society  and  Lon- 
don triumphs.  Poverty,  mortification,  and  disappointment  had 
done  their  work  upon  him,  and  he  had  risen  above  them,  ele- 
vated, purified,  and  strengthened."  (Froude,  upon  Carlyle 
leaving  "the  six  years'  imprisonment  on  the  Dumfriesshire 
moors.") 

"  He  had  laid  in,  too,  on  the  moors  a  stock  of  robust  health. 
Lamentations  over  indigestion  and  want  of  sleep  are  almost 


48  BIOGRAPHIC    CLINICS. 

totally  absent  from  the  letters  written  from  Craigenputtock. 
The  simple  natural  life,  the  wholesome  air,  the  daily  rides  or 
drives,  the  poor  food,  .  .  .  had  restored  completely  the  func- 
tions of  a  stomach  never  so  far  wrong  as  he  had  imagined. 
.  .  .  Afterwards  he  was  always  impatient,  moody,  irritable, 
violent.  These  humors  were  in  his  nature,  and  he  could  no 
more  be  separated  from  them  than  his  body  could  leap  off  its 
shadow.  ...  He  looked  back  to  it  as  the  happiest  and  whole- 
somest  home  that  he  had  ever  known.  He  could  do  fully  twice 
as  much  work  there,  he  said,  as  he  could  ever  do  afterwards 
in  London."       (Froude.) 

"  I  read  dozens  of  pages  and  find  at  the  end  that  I  have  not 
the  slightest  knowledge  what  they  were  about."  (39,  in  Lon- 
don.) 

"Mood  tragical,  gloomy,  as  of  one  forsaken."   (Ibid.) 

"  Bad  health,  too  (at  least  singularly  changed  health),  brings 
all  manner  of  dispiritment."     (Ibid.) 

"Weary,  dispirited,  sick."     (Ibid.) 

"  All  of  us  have  tolerable  health.  ...  I  am  diligent  with  the 
shower-bath;  my  pilgrimages  to  the  museum  and  on  other 
town  errands  keep  me  in  walking  enough."     (Ibid.) 

"Bilious,  too,  in  these  smothering  windless  days."     (Ibid.) 

"Broke  down  in  the  park;  konnte  nichts  mehr,  being  sick 
and  weak  beyond  measure."     (Ibid.) 

"  Many  days  of  suffering,  of  darkness,  of  despondency.  .  .  . 
Ill-health  has  much  to  do  with  it."     (Ibid.) 

"  His  name  was  not  seen  on  charity-lists,  but  he  gave  away 
every  year,  perhaps  half  what  he  received.     (Froude.) 

"All  the  mornings  he  was  at  his  desk;  in  the  afternoons  he 
took  his  solitary  walks  in  Hyde  Park,  seeing  the  brilliant 
equipages,  and  the  knights  and  dames  of  fashion  prancing 
gaily  along  the  Row."     (Ibid.) 

"  His  impatience,  his  irritability,  his  singular  melancholy, 
.  .  .  were  the  effects  of  temperament  first,  and  of  a  peculiarly 
sensitive  organization;  and  secondly  of  absorption  in  his 
work,"  etc.     (Froude.) 


THOMAS    CARLYLE.  49 

"  The  first  book  of  the  French  Revolution  is  finished.  Soul 
and  body  both  very  sick."     (40.) 

"  If  literature  will  refuse  me  both  bread  and  a  stomach  to 
digest  bread,  then  surely  the  case  is  growing  clear."     (40.) 

"If  Providence  ever  did  warn,  it  warns  thee  to  have  done 
with  literature,  which  will  never  yield  thee  bread,  nor  stomach 
to  digest  bread."     (Of  himself,  aged  40.) 

"  The  pipeclay  state,  as  (^arlyle  has  designated  a  state  too 
common  with  those  who  are  too  well  furnished  with  bile." 
(Mrs.  Carlyle.) 

"  Occasionally  sharp  pain  (something  cutting  or  hard  grasp- 
ing me  around  the  heart).  .  .  .  Something  from  time  to  time 
tying  me  tight  as  it  were,  all  around  the  region  of  the  heart, 
and  strange  dreams  haunting  me."     (40.) 

"  My  sight  inward,  as  well  as  outward,  is  all  as  if  be- 
dimmed."     (40.) 

"  I  am  yellow  and  thin,  and  feel  that  a  rest  will  be  very 
welcome  and  beneficial."     (40.) 

"  *  The  accelerated  speed '  slackened  to  slow,  and  then  to  no 
motion  at  all.  He  sat  daily  at  his  desk,  but  his  imagination 
would  not  work.  .  .  .  He  locked  up  his  papers,  and  sat  for  a 
fortnight  reading  novels.  ...  He  w^ould  be  idle,  he  would  rest. 
He  would  try,  if  the  word  was  not  a  mockery,  to  enjoy 
himself."     (Froude.) 

"  My  bodily  health  is  actually  very  bad.  ...  I  am  full  of 
dyspepsia,  but  also  of  hope.  .  .  .  No  work  to-day,  as  of  late 
days  and  weeks."     (40.) 

"  He  wrote  *  with  his  heart's  blood '  in  a  state  of  fevered 
tension."     (Froude.) 

"  My  poor  nerves,  for  long  months  kept  at  the  stretch,  felt 
all  too  waste,  distracted.  .  .  .  That  things  should  come  to  a 
crisis  is  what  I  wish." 

The  fortnight's  idleness  expired.  He  had  seen  many  friends, 
he  had  walked  and  sat  in  the  park.  The  novels  had  proved 
without  charm.  He  writes  now  of  "the  perceptible  increase 
of  health  this  otherwise  so  scandalous  faulenzen   (idleness) 


so  BIOGRAPHIC    CLINICS. 

had  given  him ;  "  he  went  to  work  again  on  the  lost  volume, 
but  became  so  sick  that  he  still  made  little  progress. 

He  managed  to  complete  the  volume,  locked  it  up,  felt  "  like 
a  man  who  had  nearly  killed  himself  in  accomplishing  zero," 
and  went  to  Scotsbrig,  where  he  talked  and  smoked  and 
"  walked  far  and  fast  among  the  hills."  "  Health  is  greatly 
improved  since  I  got  hither.  Alas!  the  state  of  wreckage  I 
was  in,  fretted  to  fiddle-strings,  was  enormous.  Even  yet  after 
a  month's  idleness,  and  much  recovery,  I  feel  it  all  so  well." 
(40.) 

Even  at  Scotsbrig  "  a  little  overwork  hurts  me,  and  is  found 
on  the  morrow  to  be  quite  the  contrary  of  gain." 

Returned  to  Chelsea,  Froude  says  of  his  health :  "  Nothing 
was  essentially  the  matter,  but  he  slept  badly  from  overwork. 
Toil  was  as  severe  as  ever."  With  work  his  health  grows 
worse;  "physical  pain  is  bad  dispiritment.  ...  It  many  times 
strikes  me,  being  in  ill-health  and  so  miserable,  art  thou  not  of 
a  surety  wrong?  Why  not  quit  literature?  ...  I  am  weary 
almost  of  life  itself."     (41.) 

"Went  out  and  had  long  swift-striding  walks — till  ten — 
under  the  stars.  .  .  .  The  unrested  horse  or  writer  cannot 
work.  .  .  .  Have  had  two  or  three  days  of  the  most  perfect 
rest  now.  .  .  .  Have  finished  Chapter  I.,  .  .  .  and  gone  idle 
for  a  week  after,  till  as  usual,  I  am  now  reduced  to  a  caput 
mortuum  again."     (41.) 

"  My  printers  had  only  ceased  the  day  before ;  I  was  wasted 
and  fretted  to  a  thread.  My  tongue,  let  me  drink  as  I  would, 
continued  as  dry  as  a  charcoal."     (42.) 

"  My  health  is  not  fundamentally  hurt.  Rest  will  cure  me. 
I  grow  better  daily.  I  delve,  I  walk  much,  generally  alone 
through  the  lanes  and  parks."     (42.) 

"  He  fled  to  Scotland  fairly  broken  down.  He  had  fought 
and  won  his  long  battle.  The  reaction  had  come,  and  his 
strangely  organized  nervous  system  was  shattered."  (Froude, 
June,  1837.) 

"  My  soul's  one  wish,"  he  writes  from  Scotland,  "  is  to  be 


THOMAS    CARLYLE.  5^ 

left  alone,  to  hear  the  rustle  of  the  trees,  the  music  of  the  bum, 
and  lie  vacant,  as  ugly  and  stupid  as  I  like.  ...  I  am  doing 
nothing;  witnessing  nothing.  My  stupidity  is  great.  .  .  .  They 
say  I  am  growing  better,  looking  better."  "  With  talk  and 
locomotion,  the  days  pass  cheerily."     (42.) 

Returned  to  Chelsea,  he  attended  "a  party"  and  returned 
about  one  in  the  morning,  "  with  a  headache  that  served  me 
for  more  than  a  day  after,  .  .  .  sick  and  nervous."  He  "did 
nothing  all  winter."     (43.) 

There  is  a  shivering  precipitancy  in  me,  which  makes 
emotion  of  any  kind  a  thing  to  be  shunned.  "  It  is  my  nerves, 
my  nerves.  .  .  .  Such  a  nervous  system  as  I  have.  .  .  .  Thomas 
feeling  in  his  breast  for  comfort  and  finding  bilious  fever.  .  .  . 
All  palpitating,  fluttered  with  sleeplessness  and  drug-taking, 
etc.  .  .  .  Weary  and  worn  with  dull  blockheadism,  chagrin 
(next  to  no  sleep  the  night  before)."     (43.) 

"  Nothing  keeping  him  in  health  so  much  as  riding."     (43.) 

"Dyspepsia  working  continually.  .  .  .  Dispirited,  in  miser- 
able health.  .  .  .  Ride  daily.  .  .  .  Swift  riding  and  solitude. 
.  .  .  For  two  hours  every  day  I  have  almost  an  immunity  from 
pain.  .  .  .  Health  perceptibly  improved.  I  have  distinctly  less 
pain  in  all  hours."     (44.) 

"  Going  into  society  "  was  "  at  the  cost  of  a  shattered  set  of 
nerves  and  head  set  whirling  for  the  next  48  hours."     (45.) 

"  I  pass  my  days  under  the  abominable  presence  of  physical 
misery — a  man  foiled.  I  mean  to  ride  diligently  for  three  com- 
plete months,  try  faithfully  whether  in  that  way  my  insup- 
portable burden  and  imprisonment  cannot  be  alleviated  into  at 
least  the  old  degree  of  endurability."     (45.) 

"  I  am  sick  and  very  miserable.  I  have  kept  riding  for  the 
last  two  months.  My  health  seems  hardly  to  improve.  I  have 
been  throwing  my  lectures  upon  paper.  ...  If  I  were  a  little 
healthier, — ah,  me !   all  around  would  be  well."    (45.) 

"A  head  full  of  air;  you  know  that  wretched  physical  feel- 
ing; I  had  been  concerned  with  drugs,  had  awakened  at  five, 
etc.     It  is  absolute  martyrdom."     (45.) 


52  Biographic  cLiNicS. 

At  the  height  of  his  success,  complaints  grow  more  bitter; 
he  longed  to  be  in  the  country ;  "  I  shall  never  be  other  than 
ill,  wearied,  sick-hearted,  etc.  .  .  .  Bilious,  heartless  and  for- 
lorn. .  .  .  Sick,  sleepless,  driven  half  mad."  (His  horse  had 
been  given  up  as  too  expensive.) 

"  My  reading  goes  on ;  my  stupidity  seems  to  increase  with  it 
more  and  more.  .  .  ."  Walking  and  solitude  are  "indis- 
pensable "  for  health.  "  I  am  sure  to  be  sick  everywhere." 
(45.) 

"  One  asks  with  wonder  why  he  found  existence  so  intoler- 
able. .  .  .  He  was  now  successful  far  beyond  his  hopes.  The 
fashionable  world  admired  and  flattered  him.  The  cleverest 
men  had  recognized  his  genius,  and  accepted  him  as  their  equal 
or  superior.  He  was  listened  to  with  respect  by  all;  and,  far 
more  valuable  to  him,  he  was  believed  in  by  a  fast  increasing 
circle  as  a  dear  and  honored  teacher.  His  money  anxieties 
were  over.  If  his  liver  occasionally  troubled  him,  livers 
trouble  most  of  us  as  we  advance  in  life,  and  his  actual  con- 
stitution was  a  great  deal  stronger  than  that  of  ordinary  men. 
.  .  .  Why  could  not  Carlyle,  with  fame  and  honor  and  troops 
of  friends,  and  the  gates  of  a  great  career  flung  open  before 
him,  and  a  great  intellect  and  a  conscience  untroubled  by  a 
single  act  which  he  need  regret,  bear  and  forget  too?  Why 
indeed!  The  only  answer  is  that  Carlyle  was  Carlyle." 
(Froude.) 

"  Want  of  rest  in  the  past  summer  had  upset  Carlyle's 
internal  system.  Work  he  could  not."  He  went  to  Fryston. 
"  My  hope  and  expectation  is  that  I  shall  improve  in  health 
here."     (46.) 

But,  "there  was  no  help  for  it;  he  had  to  do  what  in  the 
past  year  he  knew  he  must  do,  allow  himself  a  season  of  com- 
plete rest  and  sea  air."  At  Scotsbrig :  "  I  grow  daily  better, 
and  am  really  very  considerable  recovered  now."     (46.) 

The  meaning  of  the  word,  idle,  to  Carlyle,  is  to  be  kept  in 
mind.  Note  that  reading  is  never  wholly  discontinued.  While 
at  Scotsbrig  lazy  and  idling,  he  writes  in  his  journal:    "Much 


THOMAS    CARLYLE.  53 

French  rubbish  of  novels  read,  a  German  book,  etc.  Nothing 
read,  nothing  thought,  nothing  done."  Reading  was  only 
relatively  less,  and  out-of-door  life  far  greater  than  usual. 
Later  he  says,  "  I  do  not  read  much." 

"  I  cannot  be  healthy  anywhere  under  the  sun."     (47.) 

"  What  a  pity  a  man  cannot  sleep,  and  so  live  something 
like  other  men.  .  .  .  My  sleep  was  a  sleep  as  of  hospitals,  of 
men  in  a  state  of  asphyxia,  a  confused  tumult,  a  shifting  from 
headache  to  headache."     (Ibid.) 

"  No  man  was  lately  busier,  and  few  sicklier,  than  I  now 
am.  Work  is  not  possible  for  me  except  in  a  red-hot  element 
which  wastes  the  life  out  of  me.  I  have  still  three  weeks  of 
the  ugliest  labor  (correcting  proofs),  and  shall  be  fit  for  a 
hospital  then."     (48.) 

"The  lassitude  that  always  followed  the  publication  of  a 
book."     (Froude.) 

"  Past  and  Present "  was  completed  in  February,  1843,  and 
after  six  months  of  resting  and  touring  he  had,  at  Scotsbrig, 
in  August,  "no  appetite  for  writing,  for  speaking,  or  in  short, 
doing  anything  but  sitting  still  as  a  stone."     (48.) 

"  These  were  times  when  Carlyle  was  like  a  child  and  a 
very  naughty  one."  "  His  work  would  not  go,  .  .  .  his  task 
seemed  impossible."  (Froude,  after  the  return  to  Chelsea  in 
October.) 

"  The  dinner  hour  was  changed  to  the  middle  of  the  day  to 
improve  the  biliary  condition.  No  result  came.  He  walked 
about  the  streets  to  distract  himself."  "  So  it  was,  is,  and 
must  be  with  every  serious  man  when  he  is  first  starting  upon 
any  great  literary  work."     (49.) 

"  Above  a  hundred  museum  headaches."     (49.) 

"  My  progress  in  '  Cromwell '  is  frightful.  I  am  no  day 
absolutely  idle,  but  the  confusions  that  lie  in  my  way  require 
far  more  force  of  energy  than  I  can  muster  on  most  days,  and 
I  sit,  not  so  much  working  as  painfully  looking  on  work." 
(49.) 

"  Lack  of  sleep  and  dull  headache.     Very  stupid."     (49.) 

"As  a  preliminary"  (to  finishing  "Cromwell,"  and  getting 


54  BIOGRAPHIC    CLINICS. 

away  on  the  road)  "  I  have  started  to-day,  by — a  blue  pill  and 
castor."    (49.) 

"The  devil  of  sleeplessness  and  indigestion."  (49,  just 
finishing  "  Cromwell.") 

**  Cromwell  thus  disposed  of  (August  25)  he  was  off  to 
Scotland  .  .  .  dreadfully  bilious,  and  almost  sick  of  his  life." 
(Froude.) 

"Then  troublesome  proof  sheets  came  which  would  stir  the 
bile  a  little."  "  I  seem  to  improve  in  health  a  little,  but  still 
do  not  sleep.  The  habit  of  utter  idleness  getting  possession  of 
me  is  very  strange."     (50.) 

"Very  unwell;"  "sleepless,"  "totally  idle,  trying  merely  to 
read  books,  and  the  books  a  disgust  to  him."    (51.) 

"  A  huge  nightmare  of  indigestion,  insomnia,  and  fits  of 
black  impatience  with  myself  and  others, — self  chiefly.  ...  I 
am  heartily  sick  of  my  dyspeptic  bewilderment  and  imprison- 
ment."    (52.) 

"  For  two  years  now  I  have  been  as  good  as  totally  idle, 
composedly  lying  fallow.  It  is  frightful  to  think  of.  After 
getting  out  of  *  Cromwell '  my  whole  being  seemed  to  say, 
more  sulkily,  more  weariedly  than  ever  before,  '  What  good  is 
it  ?'  I  am  wearied  and  near  heartbroken.  Nobody  on  the  whole 
'believes  my  report.*"     (53.) 

"  Never  till  now  was  I  so  low — utterly  dumb  this  long 
while,  barren,  undecided,  wretched  in  mind."  "  Never  spent 
five  lonelier,  idler  weeks."     (54.) 

"Little  done  hitherto,  nothing  definite  done  at  all."    (54.) 

"  My  work  needs  all  to  be  done  with  my  nerves  in  a  kind 
of  blaze ;  such  a  state  of  soul  and  body  as  would  soon  kill  me, 
if  not  intermitted."  "I  have  to  rest  accordingly;  to  stop  and 
sink  into  total  collapse,  to  get  out  of  which  again  is  a  labor  of 
labors."     (54.) 

"  I  am  getting  weary  of  suffering,  feel  as  if  I  could  sit  down 
in  it  and  say,  well  then,  I  shall  soon  die  at  any  rate."    (55.) 

"  I  had  no  idea  I  was  so  sick  of  heart  and  had  made  such 
progress  toward  age  and  steady  dispiritment.    Alas!   alas!    I 


THOMAS    CARLYLE.  55 

ought  to  be  wrapped  in  cotton  wool,  and  laid  in  a  locked 
drawer  at  present.  I  can  stand  nothing.  I  am  really  ashamed 
of  the  figure  I  cut,"  etc.     (55.) 

"  Robust  constitutional  strength  .  .  .  was  not  among  the 
gifts  which  Nature  had  bestowed  upon  Carlyle."     (Froude.) 

"In  hope,  desire,  or  outlook,  so  far  as  common  mortals 
reckon  such,  I  never  was  more  bankrupt."     (55.) 

He  had  been  prevailed  to  sit  for  his  portrait :  "  No  more 
abominable  blotch,  without  one  feature  of  mine.  ...  It  is  the 
portrait  of  an  idiot  that  has  taken  Glauber's  salts  and  lost  his 
eyesight.    We  burn  it  and  forget  it."     (56.) 

"  He  fled  to  Malvern  for  the  water-cure,  and  became,  with 
his  wife  for  a  few  weeks  the  guest  of  Dr.  Gully.  .  .  .  The 
bathing,  packing,  drinking,  proved  useless — worse,  in  his 
opinion,  than  useless.  '  He  found  by  degrees  that  water,  taken 
as  a  medicine,  was  the  most  destructive  drug  he  had  ever 
tried.'  He  *had  paid  his  tax  to  contemporary  stupor.'  .  .  . 
He  hastened  to  hide  himself  in  Scotsbrig,  full  of  gloom  and 
heaviness,  and  totally  out  of  health."     (56.) 

"  Although  beginning  *  Frederick '  he  is  glad  to  get  home  to 
a  slighter  measure  of  dyspepsia,  inertia,  and  other  heaviness, 
ineptitude  and  gloom."     (57.) 

"  Writing  of  all  kinds  in  these  sad  biliary  circumstances, 
with  half-blind  eyes."     (57.) 

During  the  trip  to  Germany  loss  of  sleep  is  complained  of, 
but  "  on  the  whole,  was  not  so  unhappy  after  all."  "  He  could 
not  conceal  that  he  was  pretty  well,  and  had  nothing  really  to 
complain  of."     (57.) 

"  My  survey  of  the  last  eight  or  nine  years  of  my  life  yields 
little  *  comfort,'  "  etc.  "  Health  miserable;  "  "  diseased  liver;  " 
"  cannot  yet  learn  to  sleep  well.  .  .  .  For  the  rest,  I  guess  it  is 
a  change  of  epoch  with  me,  going  on  for  good  perhaps.  I  am 
growing  to  perceive  that  I  have  become  an  old  man."     (57.) 

"She  (Mrs.  Carlyle)  reads  now  with  specs  in  the  candle- 
light, as  well  as  I;  uses  her  mother's  specs,  I  perceive,"  etc. 
(58.) 


56  BIOGRAPHIC    CLINICS. 

"  Here  are  now  ten  years,  and  what  account  can  I  give  of 
them?  The  work  done  in  them  is  very  small,  even  in  com- 
parison."    (58.) 

"  I  really  feel  almost  better  than  I  have  done  in  late  years ; 
.  .  .  it  is  strange  how  little  decay  I  feel;  nothing  but  my  eye- 
sight gone  a  very  little."     (58.) 

The  sensitiveness  to  noise  continues — "the  great  cock  ques- 
tion "  is  settled,  but  "  Frederick  "  does  not  make  the  headway 
desired,  because  he  is  "  in  a  heavy  stupefying  state  of  health," 
and  he  is  afflicted  with  terrible  dreams.  "  Nearly  all  of  my 
dreams  in  this  world  have  come  from  bodily  conditions  of  the 
nerves,  I  think."     (59.) 

"My  eyes  are  very  dim;  bad  light  (from  the  sky  direct) 
though  abundant."     (59.) 

After  eighteen  months  at  "  Frederick,"  "  all  things  go 
prosperously,"  and  he  sleeps  well.     (60.) 

"Doing  really  excellently  well  as  regards  health."     (62.) 

"  Villainous  headaches,"  "  feverish  headaches "  come  on 
with  his  proofs  all  day,  but  "the  world  was  well;  all  was 
well,"  generally  speaking,  and  "indoors  the  old  affectionate 
days  had  come  back."     (62.) 

At  the  completion  of  his  six  years'  task  (Frederick)  he  was 
"  slightly  out  of  health  " ;  took  a  trip  to  Germany,  "  improves 
in  bodily  health,  and  sleeps  well."     (63.) 

There  are  some  complaints  henceforth,  of  nerves,  stomach, 
darkness,  stupidity,  etc.,  but  they  are  not  so  frequent,  nor  by 
any  means  so  passionate  as  formerly.  He  "  worked  without 
respite,  rode  except  on  walking  days,  chiefly  late  in  the  after- 
noon, in  the  dark  of  the  winter  months,"  etc.     (67-68.) 

"  I  have  mainly  consorted  with  my  horse  for  eight  years 
back."     (69.) 

He  was  thrown  from  his  horse  and  hurt  in  1868  (73  years 
old),  and  renounced  riding  thenceforth. 

Tremulousness  and  twitching  of  the  right  hand  came  on  in 
1870,  and  made  writing  impossible. 

At  the  age  of  80  he  had  "  bright  reminiscences  of  health." 


THOMAS    CARLYLE.  57 

"  He  was  attended  by  a  Scotch  physician.  He  disliked  doc- 
tors generally,  and  through  life  had  allowed  none  of  them 
near  except  his  brother;  but  he  now  submitted  to  occasional 
visits."     (83.) 

He  died  February  5,  1881,  aged  85. 

If  the  theory  I  have  formed  of  the  origin  of  Carlyle's 
ill-health  is  correct,  the  reasons  that  the  first  appear- 
ance of  symptoms  is  so  late  as  at  the  age  of  23  may  be 
one  or  more  of  three : 

1.  Symptoms  of  headache,  indigestion,  etc.,  during 
boyhood  may  not  have  been  recorded.  Very  often 
such  symptoms  take  the  form  of,  or  are  supposed  to 
be,  other  diseases. 

2.  His  sound  constitution  and  fine  Scotch  inheritance 
from  a  rugged,  resistant,  and  healthful  ancestry  en- 
abled him  to  conquer  disease  in  the  critical  period  of 
youth,  when  another  would  have  succumbed.  There  is 
also  no  evidence  that  he  was  a  hard  student  as  a  boy. 

3.  His  "  error  of  refraction  "  may  not  have  developed 
until  his  twenty-second  or  twenty-third  year.  During 
this  growing  period  astigmatism  and  other  optical 
defects  may  increase  or  decrease  in  a  few  years  or  even 
a  few  months.^ 

^  I  have  had  one  fine  boy  as  a  patient  whose  eyes  had  to  be 
retested  every  few  months  and  whose  astigmatism  steadily 
increased  from  a  low  degree  until  it  became  very  high  as  he 
approached  manhood.  Whenever  his  astigmatism  had  in- 
creased one  half  of  a  diopter  everything  eaten  would  at  once 
be  vomited,  until  his  spectacles  had  been  changed.  Persistence 
of  neglect  resulted  in  positive  emaciation. 
5 


$8  BIOGRAPHIC    CLINICS. 

Upon  entering-  adult  life  Fate  knocked  at  Carlyle's 
door  as  abruptly,  ominously,  and  clearly  as  at  the 
beginning  of  Beethoven's  Fifth  Symphony.  While  a 
student  at  Edinburgh,  and  applying  himself  severely, 
dyspepsia  seized  upon  him  with  the  train  of  symptoms 
so  persistently  and  clearly  described  by  him  for  almost 
exactly  40  years.  He  spoke  of  the  next  three  years  as 
"  the  most  miserable  of  his  life,"  but  it  is  plain  that 
from  42  to  56  his  sufferings  were  far  more  intense. 
The  bitter  want  of  sleep,  and  complaint  of  noise,  and 
the  heartrending  heartsickness,  intermitted  only  dur- 
ing the  life  at  Craigenputtock,  for  the  four  coming 
decades.  That  they  did  stop,  and  exactly  when  the 
accommodating  function  was  paralyzed  by  age — this  is 
to  me  a  most  significant  fact.  With  most  noteworthy 
wisdom  he  says  at  57 :  "  It  is  a  change  of  epoch  with 
me,  going  on  for  good  perhaps.  I  am  growing  to  per- 
ceive that  I  have  become  an  old  man."  The  full  estab- 
lishment of  presbyopia  is  the  beginning  of  old  age  with 
every  man. 

Carlyle's  Constitution. — With  characteristic  froudery 
his  biographer  thus  alludes  to  Carlyle's  physical  endow- 
ment in  three  different  places: 

(a)  "  His  actual  constitution  was  a  great  deal  stronger  than 
that  of  ordinary  men." 

(6)  "  His  health  was  essentially  robust." 

(c)  "Robust  constitutional  strength  was  not  among  the 
gifts  which  nature  had  bestowed  upon  Carlyle." 


THOMAS    CARLYLE.  59 

This  is  a  minor  one  of  the  thousand  illustrations  of 
the  inexplicable  blunder  Carlyle  committed  in  entrust- 
ing his  manuscripts  and  biography  to  the  ineptitude  of 
this  caricature  "  Greek  Chorus."  How  unconquerably 
tough  and  sound  must  have  been  the  natural  consti- 
tution that,  after  40  years  of  continuous  daily  excruciat- 
ing torment,  could  enjoy  22  years  of  healthy  old  age, 
and  die  at  the  ripe  age  of  85.  At  58  Carlyle  says :  "  It 
is  strange  how  little  decay  I  feel;  nothing  but  my 
eyesight  gone  a  little."  At  60  "  the  world  was  well ; 
all  was  well."  Even  at  41  he  says  of  himself  that 
"  nothing  was  essentially  the  matter,"  and  at  42,  "  my 
health  is  not  fundamentally  hurt." 

His  physiologic  habits  were  also  of  the  best  possible. 
His  food  was  always  of  the  simplest  but  it  had  to  be  of 
the  best  quality,  usually  sent  from  the  old  Scotch  home. 
He  was  careful,  he  was  compelled  to  be  most  careful, 
in  all  matters  of  personal  hygiene,  as  regards  exercise, 
etc.,  and  physical  sin  was  as  impossible  to  him  as 
moral  sin.  The  reader  of  his  life  and  letters  will  per- 
haps wonder  if  tobacco  may  have  had  anything  to  do 
with  his  irritability  and  bad  health.  But  smoking  (in 
moderation  as  Carlyle  practised  it)  does  not  have  that 
physiologic  effect,  as  millions  can  testify.  Carlyle's 
judgment  in  this  and  in  many  such  matters  was  most 
accurate.  Some  Edinburgh  physician  in  the  early 
years  of  his  "  dyspepsia  "  had  told  him  that  tobacco 
was  the  cause  of  his  digestional  difficulty,  and  by  his 


6o  BIOGRAPHIC    CLINICS. 

advice  he  gave  it  up,  but  "  found  I  might  as  well  have 
poured  my  sorrows  into  the  long  hairy  ear  of  the  first 
jackass  I  came  upon  as  of  this  select  medical  man."^ 
And  he  rightly  continued  the  habit  to  the  day  of  his 
death.  One  of  the  earliest,  most  continuous,  and  latest 
grievances  was  insomnia.  "  It  goes  to  my  heart  when 
he  told  me  in  his  last  letter  that  he  could  not  sleep 
without  his  finger  in  his  ear."  All  oculists  know  that 
insomnia  is  one  of  the  most  common  and  persistent 
symptoms  of  eye-strain. 

What  I  have  called  the  second  critical  period  ended 
with  Carlyle  at  about  the  age  of  32,  and  the  six  years 
at  Craigenputtock  were  the  happiest  he  was  ever  to 
have — for  after  60  there  were  other  reasons  than  phys- 
ical for  unhappiness.    Like  De  Quincey  (and  Hke  Dar- 

^  That  Carlyle's  judgment  concerning  those  physicians  he 
met  was  not  far  wrong,  I  quote  the  following  remarkable 
"  clinical  observations "  from  the  British  Medical  Journal, 
November  9,  1895,  page  1147. 

"  The  late  Mr.  Carlyle  was  a  patient  of  mine.  As  all  the 
world  knows  he  was  a  man  of  great  j  udgment  and  great  power 
of  observation.  With  regard  to  himself,  the  only  remedy  I 
could  ever  get  him  to  take  was  grey  powder.  He  lived  to  82 
or  83.  Grey  powder  was  his  favorite  remedy  when  he  had  that 
wretched  dyspepsia  to  which  he  was  subject,  and  which  was 
fully  accounted  for  by  the  fact  that  he  was  particularly  fond 
of  very  nasty  gingerbread.  Many  times  I  have  seen  him 
sitting  in  the  chimney  corner  smoking  a  clay  pipe  and  eating 
this  gingerbread.  He  overcame  the  difficulties  incident  to 
this  habit  by  his  grey  powder,  which  did  him  much  good." 
(Sir  R.  Quain.) 


THOMAS    CARLYLE.  6i 

win,  Huxley,  and  Browning  also)  Carlyle  found  that 
the  sole  and  absolute  condition  of  ability  to  read  and 
write  as  well  as  to  live,  was  continuous  and  prolonged 
exercise  in  the  open  air.  When  he  could  afford  a 
riding  horse  he  was  better.  A  large  part  of  his  life 
was  spent  in  riding  horseback  (he  speaks  of  one  of  his 
horses  having  carried  him  20,000  miles),  or  in  walking, 
often  in  the  night.  Besides  the  quiet,  the  eye-resting 
distance,  etc.,  this  is  another  reason  why  he  was  so 
much  better  at  Craigenputtock.  "He  could  do  fully 
twice  as  much  work  there  as  in  London."  The  more 
he  read  and  wrote  the  worse  his  health.  Many  quota- 
tions show  that  he  knew  the  direct  relationship  between 
writing  and  distress.  In  the  forenoons  at  his  desk  he 
fights  with  dulness  and  bile  "  as  of  old,"  while  in  the 
hours  of  riding  in  the  afternoon  he  has  "  almost  an 
immunity  from  pain."  He  even  reduced  the  fact  to  a 
generalization,  finding  that  literary  work  caused  his 
suffering : 

"  If  literature  will  refuse  me  both  bread  and  a  stomach  to 
digest  bread  " — 

"  If  Providence  ever  did  warn  it  warns  me  to  have  done 
with  literature  which  will  never  yield  the  bread  nor  the 
stomach  to  digest  bread." 

"  I  had  made  myself  bilious  enough  with  my  writing." 

But  thousands  of  other  people  all  over  the  world 
work  at  literary  work  many  more  hours  a  day  than  did 
Carlyle  and  without  "upsetting  the  stomach,"  "derang- 
ing the  liver,"   or  producing  irritability  and  melan- 


62  BIOGRAPHIC    CLINICS. 

cholia.  There  are  a  few  million  in  the  world  in  whom 
these  are  the  results  of  the  use  of  the  eyes  at  near 
range,  but  there  are  many  more  millions,  clerks,  sew- 
ing-women, craftsmen,  artists,  etc.,  who  have  no  such 
troubles. 

His  Symptoms. — Throughout  the  annotations  of 
the  unendurable  are  scattered  the  insinuations  that 
Carlyle's  sufferings  were  largely  the  products  of  his 
disordered  fancy.  "  His  imagined  ill-health,"  he  says : 
"  He  saw  his  ailments  through  the  lens  of  his  imagi- 
nation " ;  "  it  .was  in  his  nature  " ;  "  he  could  not  con- 
ceal that  he  was  pretty  well  and  had  nothing  really  to 
complain  of  " ;  "  why  at  the  acme  of  success  and  fame 
could  he  not  bear  and  forget  too  ?  Why  indeed !  The 
only  answer  is  that  Carlyle  was  Carlyle," — a  hundred 
such  poor  sneers  could  be  gathered.  But  no  man  not 
eaten  up  with  incorrigible  conceit  can  read  the  pathetic 
record  of  those  forty  years  of  poignant  wretchedness 
and  doubt  the  reality  of  the  suffering.  The  physician 
who  has  heard  the  same  pitiful  recitals  of  anguish 
from  his  patients  recognizes  the  utter  sincerity  of 
Carlyle's  utterance :  "  Am  getting  weary  of  suffering, 
feel  as  if  I  could  sit  down  in  it  and  say,  well  then,  I 
shall  soon  die,  at  any  rate."  ''  I  am  near  heartbroken. 
Nobody  on  the  whole  believes  my  report." 

As  regards  his  irritableness,  melancholia,  and  mental 
misery  generally,  Froude  says  in  a  hundred  ways  and 
"  insinuendos  "  it  was  all  in  ''his  nature,"  that  he  could 


THOMAS    CARLYLK  63 

no  more  escape  from  these  things  than  his  body  '*  could 
leap  off  its  shadow,"  etc.  But  what  more  beautiful 
character  ever  showed  itself  than  in  the  early  essays? 
The  man  who,  poor  and  self-denying  as  he  was, 
secretly  gave  away  to  the  poor  at  least  half  his  income, 
and  who  honored  his  father  and  passionately  loved  his 
mother — he  a  genius,  they  peasants;  the  man  who 
wrote  and  felt  to  Mrs.  Carlyle  as  he  did — such  a  man 
was  to  be  honored  rather  than  pitied.  As  regards 
religion,  so  as  to  literary  work,  he  could  neither  accept 
nor  reject,  and  in  both  he  was  compelled  to  follow  the 
advice  of  Clough — 

"Take  it  not  and  leave  it  not 
But  fight  it  out,  O  Man!" 

Carlyle  himself  knew  better :  "  I  declare  solemnly 
without  exaggeration  that  I  impute  nine-tenths  of  my 
present  wretchedness,  and  rather  more  than  nine- 
tenths  of  all  my  faults  to  this  infernal  disorder  in  the 
stomach."  "  On  days  when  moderately  well  I  feel  as 
happy  as  others;  happier,  perhaps,"  and  a  thousand 
lines  could  be  quoted  as  lovely  and  as  true  as,  "  The 
world  is  God's  world,  and  wide  and  fair."  Even  poor 
Mrs.  Carlyle,  who  "  married  for  ambition,"  could  but 
say,  "  My  husband  is  as  good  company  as  reasonable 
mortal  could  desire."  That  he  was  at  times  gloomy, 
irritable,  morose,  harsh,  etc.,  no  one  would  deny,  least 
of  all  Carlyle  himself.  But  that  it  was  his  essential 
nature  to  be  so — every  page  of  the  letters  gives  the  lie 


64  BIOGRAPHIC    CLINICS. 

to  this  faithless  indictment.  Those  things  were  simply 
the  symptoms  of  his  awful  disease. 

Carlyle  had  throughout  his  life  more  or  less  of  what 
American  oculists  call  "  theater  headaches  "  or  "  pano- 
rama headaches."  A  great  many  of  our  patients,  until 
eye-strain  has  been  stopped  by  glasses,  cannot  attend 
banquets,  concerts,  theaters,  etc.,  without  disastrous 
effects  to  head  and  "  nerves."  When  Carlyle  went 
much  to  the  Museum  he  had  what  he  called  "  musseum 
headaches."  When  he  went  to  a  "  party  "  he  returned 
with  "  headache  and  shattered  nerves,"  and  vowing 
never  to  do  such  a  foolish  thing  again. 

As  regards  the  actual  ocular  conditions,  the  refrac- 
tion, etc.,  we  have  in  Carlyle*s  case  the  indefiniteness  we 
should  expect.  Illuminating  suggestions  may  exist  in 
letters  not  printed.  The  complaint  of  musccB  volitantes 
spoken  of  in  the  Emerson  letter  (Vol.  I.,  p.  91)  has  no 
significance  whatever,  and  his  explanation  of  it  (as 
"  part  of  the  retina  protesting  against  the  liver  and 
striking  work  ")  is  as  childish  physiology  as  any  sav- 
age "  medicine-man  "  could  devise.  So  far  as  concerns 
conditions  of  ocular  work  we  must  not  forget  the 
increased  difficulty  in  dark,  smoky  London,  and  from 
the  use  of  "  farthing  rush-lights  "  and  candles.  The 
first  complaint  of  "  dimmed  sight "  is  at  40.  At  42 
"  reading  proof  wasted  and  fretted  him  to  a  thread  and 
made  his  tongue  as  dry  as  charcoal."  At  56  the 
painter  of  his  portrait  could  not  help  carrying  to  the 


THOMAS    CARLYLE.  65 

canvas  the  pained,  exhausted  look  of  eye-strain  to  be 
seen  in  all  the  later  portraits  of  him,  and  which  tells 
the  oculist  with  the  first  glance  at  many  patients  the 
epitome  of  years  of  morbid  ocular  labor.  Carlyle  said 
the  picture  was  of  "  an  idiot  that  had  taken  Glauber's 
salts  and  lost  his  eyesight,"  and  he  was  disgusted  in  a 
Carlylean  way.  At  57  he  spoke  of  "  half-blind  eyes." 
At  58  the  note  about  "  specs  "  is  so  vague,  we  cannot 
draw  any  conclusions  from  it.  It  only  shows  the  old, 
old,  popular  folly  of  picking  up  mother's  specs  or 
grandmother's,  when  irreparable  injury  has  been  done 
and  life  nearly  lived  out  and  suffered  away.  "  Eye- 
sight gone  a  little,"  at  58,  tells  probably  of  the  ambly- 
opia that  finally  follows  long  lack  of  correction  of 
ametropia,  and  "  eyes  very  dim  even  with  abundant 
light,"  at  59,  emphasizes  the  fact,  and  also  almost 
demonstrates  the  existence  of  astigmatism,  which 
failed  accommodation  revealed  and  which  no  common 
optician's  (spherical)  lenses  could  help.  That  the 
ametropia  was  not  due  to  cataract  is  certain  because  he 
retained  useful  vision  for  26  years  afterward.  Head- 
aches with  proof-reading  at  62  show  the  return  of  the 
reflex  neurosis  to  the  head  instead  of  as  formerly 
almost  solely  to  the  digestive  organs. 

His  treatment  of  himself — for  he  took  no  physi- 
cian's advice  but  once  and  for  a  brief  time — was 
chiefly  by  castor  oil,  which  he  felt  obliged  to  take  most 
of  his   life,   and   most   copiously   and   constantly   the 


66  BIOGRAPHIC    CLINICS. 

greater  the  amount  of  his  "  biliousness  "  and  of  his 
correlated  eye-strain.  At  times  we  hear  of  salts  and 
of  blue  pill  in  addition  to  the  castor.  It  is  evident,  I 
think,  that  the  digestive  function  was  inhibited,  and 
that  the  bile  was  deficient  instead  of  the  reverse,  as  his 
descriptions  would  imply.  It  is  a  poor  oculist  that 
has  not  learned  that  eye-strain  produces  constipa- 
tion. Many  thousands  of  American  patients  know  it 
well. 

Carlyle's  opinion  of  the  medical  profession  was,  so 
far  as  concerned  his  own  case,  entirely  justified  and 
justifiable.  Had  he  consulted  a  hundred  of  the  best 
general  physicians  in  England  he  would  have  got  no 
more  help  than  from  the  one  he  sought  out  in  Edin- 
burgh. It  was  exactly  so  later  with  Darwin,  Huxley, 
and  Browning.  "  The  stomach,"  and  "  the  liver," 
would  have  been  charged  with  bad  function,  and  travel 
and  rest  would  have  been  ordered.  Indeed  it  would  be 
precisely  the  same  story  to-day.  It  is  certainly  time 
that  the  question  were  asked.  Why  do  the  stomach  and 
liver  work  so  poorly  ?  A  functional  disease  is  a  curable 
disease  if  the  cause  of  the  malfunction  is  diligently 
sought  for.  The  fleeting  sensations  about  the  heart 
twice  spoken  of  by  Carlyle  are  of  little  consequence. 
The  Badams  incident  is,  to  a  physician,  most  amusing, 
although  it  was  serious  enough  to  Carlyle.  One  is 
almost  glad  that  the  stomach-curer  met  a  sorry  reward 
in    his    "  intolerable    headache "    "cured "    by    drink. 


THOMAS    CARLYLE.  67 

Carlyle  also  quickly  saw  through  the  nonsense  of  the 
Gully  water-cure.  The  diagnostician  who  from  the 
hundreds  of  references  made  to  his  symptoms  by  Car- 
lyle would  seek  to  gather  any  definiteness  of  pathologic 
finding  will  fail.  Picturesque,  passionate,  terrible  as 
they  are,  they  are  even  more  indefinite.  At  first  it  was 
more  clearly  stomachal,  if  we  may  trust  that  his  loca- 
tion of  this  organ  was  topographically  correct.  "  Like 
a  rat  gnawing  at  the  pit  of  his  stomach,"  are  his  words. 
But  the  complaints  of  "  nervousness,"  of  "  coorsed 
nervous  disorders,"  of  "  stupidity,"  "  sickness  of  body 
and  mind,"  "  hypochondria,"  "  sleeplessness,"  "  dull- 
ness," "  weakness,"  etc.,  make  one  wonder  just  what 
organ  was  the  most  affected.  "  Bile,"  "  bilious,"  and 
"  derangement  of  the  liver  "  are  so  commonly  repeated 
that  if  one  could  by  any  possibility  learn  what  lay  peo- 
ple mean  by  such  words  we  might  stop  to  consider  the 
blameworthiness  of  the  poor  liver.  The  pretty  nearly 
certain  thing  is  that  to  Carlyle  and  such  complainers 
the  "  liver  "  and  the  "  stomach  "  were  mythical  scape- 
goats upon  which  all  vague  miseries  could  be  laid  and 
both  properly  and  improperly  cursed.  The  sad  thing 
is  that  the  sorrows  were  not  got  rid  of  by  this  pro- 
cedure. In  fact  it  is  perhaps  true  that  when  Carlyle 
complained  of  bile,  he  should  have  complained  of  lack 
of  bile.  The  drugs  he  took  during  most  of  his  life 
would  imply  this  without  the  strange  and  strabismic 
allusion  to  the   "  '  pipeclay   state '  too  common  with 


68  BIOGRAPHIC    CLINICS. 

those  who  are  too  well  furnished  with  bile."  Indeed 
the  digestional  reflex  of  an  ocular  irritation  is  essen- 
tially inhibitive. 

On  the  whole  it  is  clear  both  from  the  profound 
reality  of  suffering  and  from  the  impossibility  of  local- 
izing it  in  any  organ,  that  there  was  never  any  organic 
disease  whatever.  "  Gastrodynia  "  there  was,  if  one 
has  any  satisfaction  in  such  tautologic  and  meaningless 
words,  and  many  other  dynias,  and  dys's,  but  not  "  gas- 
tric ulcer "  or  any  other  morbid  tissue  changes  or 
lesions.  Such  pathologic  conditions  do  not  disappear 
suddenly  at  60  years  of  age,  and  leave  one  free  for  25 
more.  The  mystery  of  his  affliction  had  struck  the 
attention  of  Carlyle  (as  under  similar  circumstances  it 
had  done  with  De  Quincey),  and  he  said,  "  What  the 
cause  is  would  puzzle  me  to  explain."  Looking  at  the 
symptomatology  more  closely  we  find  that  the  daily 
rhythm  of  the  rise  depends  exactly  upon  the  amount 
of  reading  and  writing,  and  of  the  fall  upon  the  amount 
of  disuse  of  the  eyes.  Then  there  is  the  enormously 
heightened  intensities  clustering  about  the  execution  of 
the  more  important  works.  After  each,  except  at 
Craigenputtock,  there  is  a  terrible  revulsion.  After 
the  completion  of  Meister  at  29,  things  were  so  bad  as 
to  warrant  the  sadly  ludicrous  Badams  incident.  Wide 
and  miscellaneous  reading  brings  a  great  increase 
of  the  bitter  complaints  at  the  age  of  31.  At 
Craigenputtock  he  produced  with  little  complaint  the 


THOMAS    CARLYLE.  ^9 

essay  on  Burns,  German  literature,  Characteristics, 
Diderot,  and  others,  and  the  incomparable  "  Sartor." 
Would  that  he  could  have  remained  there  the  rest  of 
his  life !  After  "  The  French  Revolution  ",  "  he  fled  to 
Scotland  fairly  broken  down,"  and  the  sufferings  of 
the  next  years  are  perhaps  the  greatest  of  his  life.  He 
produced  little  for  five  or  six  years,  and  at  the  height 
of  his  success  he  was  most  miserable.  Even  after  such 
a  small  work  as  "  Past  and  Present "  (48)  he  required 
six  months'  rest  and  travel  and  then  was  incapable  of 
work.  "  Cromwell "  took  three  years  of  his  life,  and 
was  composed  with  infinite  suffering,  and  then  is  three 
years  of  rest.  "  Frederick  "  is  begun  at  57  and  com- 
pleted at  69.  But  now  appears  the  new  phenomenon, 
what  he  calls  the  "  change  of  epoch."  Complaints  end, 
although  he  is  working  hard  at  his  great  task.  There 
is  no  working  hypothesis  except  that  of  eye-strain  that 
will  explain  all  these  things.  After  each  day's  work, 
each  essay,  each  volume,  each  entire  work,  there  was 
the  need  of  rest,  the  increase  of  poignant  complaint, 
the  exhaustion  of  despair,  the  startling  approach  to 
death  which  up  to  the  beginning  of  ''  Frederick  "  be- 
came more  and  more  frightful.  After  each  was  the 
sickness  of  weariness,  the  weariness  of  sickness,  the 
"  dulness,"  the  "  stupidity,"  the  appalling  lack  of 
energy.  But  Carlyle  knew  he  was  not  stupid,  or  dull, 
and  when  it  seemed  that  he  was  most  so,  he  could  for 
hours  roll  forth  such  brilliant  monologue  and  conversa- 


70  BIOGRAPHIC    CLINICS. 

tion  as  to  make  the  richest  and  wisest  of  the  land 
delight  to  hear  him,  and  to  invite  him  to  their  houses 
in  order  to  hear  him.  Intellectual  activity  did  not  tire 
or  hurt  him — it  was  only  intellectual  activity  plus  read- 
ing or  writing  that  soon  gave  atrocious  suffering.  This 
is  demonstrated  by  the  further  fact  that,  after  each 
work,  it  took  a  longer  time  and  a  great  and  greater 
self -scourging  to  whip  himself  into  the  new  labor.  He 
would  sit  and  stare  at  his  book  or  writing,  shut  in 
unconscious  stupor,  until  he  had  spurred  himself  into 
the  white  heat  of  passion  which  was  required  to  enable 
him  to  work,  and  which  when  it  had  passed  left  him  a 
wreck  of  exhaustion.     He  says : 

"There  is  a  shivering  precipitancy  in  me  which  makes 
emotion  of  any  kind  a  thing  to  be  shunned.  It  is  my  nerves, 
my  nerves." 

"  My  work  needs  all  to  be  done  with  my  nerves  in  a  kind  of 
a  blaze,  such  a  state  of  body  and  nerves  as  would  soon  kill 
me  if  not  intermitted.  I  have  to  rest  accordingly,  to  stop  and 
sink  into  total  collapse,  to  get  out  of  which  is  a  labor  of 
labors." 

"  He  wrote  *  with  his  heart's  blood '  in  a  state  of  fevered 
tension,"  says  Froude. 

"  Work  is  not  possible  for  me  except  in  a  red-hot  element, 
which  wastes  the  life  out  of  me." 

All  of  which  is  inexplainable  except  upon  the  theory 
that  eye-strain  was  the  cause  of  his  trouble.  It  was  not 
so  during  the  writing  of  "  Frederick  "  which,  begun  at 
the  age  of  58  or  59,  was  carried  forward  leisurely  with- 
out pain,  and  without  appalling  groans  and  cries  of 


THOMAS    CARLYLE.  71 

anguish  at  the  end.  Noticeable  also  is  the  fact,  how- 
ever, that  after  its  completion  and  during  the  last  six- 
teen years  of  his  life  there  was  practically  no  produc- 
tion of  work.  The  "  ablaze  "  and  the  "  white  heat  " 
of  his  nerves,  with  which  he  had  been  compelled  to 
work  to  develop  the  power  to  counteract  the  inhibition 
and  irritation  of  morbid  ocular  function,  had  ended  in 
final  paralysis  of  brain  and  will. 

And  Carlyle  was  actually  conscious  that  with  his 
great  powers  he  had  been  able  to  do  so  little  work. 
There  are  generally  no  better  and  more  productive 
years  than  those  between,  say,  42  and  58.  Carlyle 
writes  at  the  age  of  58 :  "  Here  are  now  ten  years,  and 
what  account  can  I  give  of  them?  The  work  done  in 
them  is  very  small  even  in  comparison."  If  I  take  the 
number  of  pages  of  the  edition  at  hand,  of  his  collected 
works,  I  find  that  they  foot  up  about  ten  thousand. 
Dividing  this  number  by  the  number  of  days  of  his 
sixty  years  of  working  life  I  find  that  he  produced  at 
the  rate  of  less  than  one  half  a  page  a  day.  If  we  sup- 
pose that  for  every  printed  page  he  read  ten  pages  to 
get  his  data,  we  find  that  the  entire  reading  and  writing 
was  thus  equal  on  the  average  to  about  five  and  one 
half  printed  octavo  pages  a  day. 

In  some  men  the  untoward  conditions  of  circum- 
stances, the  ill-health,  the  mental  abnormalism,  etc., 
may  have  little  or  no  effect  upon  the  quality  of  their 
literary  labors.    In  others  this  may  be  subtly  modified, 


72  BIOGRAPHIC    CLINICS. 

and  in  others  still  the  differences  caused  may  be  most 
profound.  Carlyle,  I  think,  is  an  example  of  the  last 
class.  Every  work  he  brought  forth  is  in  almost  every 
line  modified  by  the  direct  result  of  the  conditions  of 
eye-strain  while  engaged  upon  it.  The  very  choice  of 
subjects  are  dictated  by  it.  With  the  resistance  and 
energy  of  youth  overcoming  all  disease  we  have  the 
beautiful  objectivity,  the  combined  "  sweetness  and 
light ",  the  humor,  and  the  charm  of  the  early  essays 
and  of  "  Sartor  ".  What  could  be  more  like  his  wrecked 
soul  than  the  "  French  Revolution  ",  both  in  subject 
and  treatment  ?  History  written  by  lightning  flashes  it 
is  indeed,  but  the  lightnings  are  those  of  his  own  mind 
in  thunderstorm  that  brought  in  its  fury,  brief  peace, 
but  that  also  brought  destruction.  Again  how  impera- 
tive of  his  mood  and  how  logically  responsive  was 
"  Chartism  ",  "  Heroes  ",  "  Cromwell  ",  and  "  Past  and 
Present  "  !  But,  at  last  at  peace,  "  Frederick  "  (tak- 
ing twelve  years  to  write)  shows  what  the  character  of 
the  lifework  might  have  been  if  the  thirty-eight  pre- 
vious years  had  not  been  lived  upon  the  rack  of  atro- 
cious suffering.  The  unauthorized  pessimism,  the 
pitiable  antiscience,  the  foolish  arrogance,  the  outrage- 
ous "  Ilias  Americana  in  Nuce,"  and  all  such  things 
are  excusable.  Such  trifles  may  be  forgiven  him  in 
that  he  loved  much  and  heroically,  but  it  is  to  me 
beyond  question  that  deductive  as  his  mind  essentially 
was,  not  inductive,  prophetic  and  ethical  as  was  his 


THOMAS    CARLYLE.  73 

inevitable  function,  he  would  not  have  been  the  subject 
of  such  blundering  if  he  had  not  been  stung  to  it  by 
his  tortures.  They  were  the  groans  and  deliriums  of 
a  nervous  system  in  awful  agony. 

When  the  storms  of  the  life  voyage  were  over  Car- 
lyle  had  a  splendid  opportunity  to  gather  to  a  focus  all 
the  experience  and  wisdom  he  had  gained.  And  splen- 
didly he  improved  it!  Among  the  noble  truths  there 
glowing  with  softened  but  exquisite  light  he  urged  that 
the  function  of  universities  was  to  create  libraries  and 
teach  the  student  to  read.  Assiduity  in  reading  is  the 
great  study  of  the  intellectual  man.  There  was  not  a 
word  of  course  as  to  the  mechanism  of  reading,  and  one 
is  grieved  to  think  of  this  and  the  fact  that  the  labor  of 
reading  with  an  optically  wretched  instrument  had 
been  the  cause  of  the  speaker's  life-tragedy.  And  that 
it  would  be  the  same  with  thousands  of  his  pupils  then 
and  since! 

Lastly  comes  the  lesson  called  "  a  very  humble  one," 
but  which  not  even  he  could  realize  how  and  why  it 
was  far  from  humbly  important: 

"  In  the  midst  of  your  zeal  and  ardor,  .  .  .  remember  the 
care  of  health.  ...  It  would  have  been  a  very  great  thing  for 
me  if  I  had  been  able  to  consider  that  health  is  a  thing  to  be 
attended  to  continually,  that  you  are  to  regard  that  as  the  very 
highest  of  all  temporal  things  for  you.  There  is  no  kind  of 
achievement  you  could  make  in  the  world  that  is  equal  to 
perfect  health.  What  to  it  are  nuggets  and  millions?  The 
French  financier  said,  'Why  is  there  no  sleep  to  be  sold!' 
6 


74  BIOGRAPHIC    CLINICS. 

Sleep  was  not  in  the  market  at  any  quotation.  ...  I  find  that 
you  could  not  get  any  better  definition  of  what  *  holy'  really 
is  than  '  healthy.'  Completely  healthy ;  mens  sana  in  corpore 
sano.  A  man  all  lucid,  and  in  equilibrium.  His  intellect  a 
clear  mirror  geometrically  plane,  brilliantly  sensitive  to  all 
objects  and  impressions  made  on  it  and  imaging  all  things  in 
their  correct  proportions;  not  twisted  up  into  convex  or 
concave,  and  distorting  everything  so  that  he  cannot  see  the 
truth  of  the  matter,  without  endless  groping  and  manipula- 
tion :  healthy,  clear,  and  free  and  discerning  truly  all  around 
him." 

He  is  compelled  by  the  very  nature  and  mathematics 
of  the  subject  to  use  the  images  of  physical  and  physio- 
logic optics.  It  is  as  necessary  for  the  eye  to  be 
optically  right  as  for  the  intellect.  Moreover,  he  did 
not  know,  as  even  then  he  might  have  known,  that  the 
intellect  whose  function  he  could  best  describe  in 
optical  terms  is  psychologically  most  literally  and  abso- 
lutely the  creation  of  the  act  of  vision.  It  has  the  quali- 
ties of  geometric  and  imaging  perfection  only  because 
by  the  heredity  of  millions  of  years  the  optically  cor- 
rect, or  approximately  correct,  eyes  of  innumerable 
ancestors  have  produced  the  optically  correct  intellect. 
The  acme  of  physical  and  intellectual  suffering  is  to 
supply  a  correct  intellect,  the  product  of  eyes,  with  an 
optically  morbid  pair  of  eyes,  and  compel  them  to  work 
for  sixty  years  against  the  demands  of  the  laws  of  all 
past  time. 

Let  us  make  one  last  quotation  from  the  inaugural 
address.    In  the  face  of  the  fact  that  numberless  thou- 


THOMAS    CARLYLE.  75 

sands  and  even  millions  of  hard  eye- workers  (literary 
and  others)  are  clear-sighted  physically  and  mentally, 
and  have  no  considerable  suffering  therefrom — despite 
this  which  Carlyle  should  have  thought  of,  he  says : 

"  We  can  never  attain  that  [the  holy  and  healthy,  optically 
perfect  intellect]  at  all.  .  .  .  You  cannot,  if  you  are  going  to 
do  any  decisive  intellectual  operation  that  will  last  a  long 
while;  if,  for  instance,  you  are  going  to  write  a  book — you 
cannot  manage  it  (at  least  I  never  could)  without  getting 
decidedly  made  ill  by  it:  and  really  one  nevertheless  must; 
if  it  is  your  business,  you  are  obliged  to  follow  out  what  you 
are  at,  and  to  do  it,  if  even  at  the  expense  of  health.  Only 
remember  at  all  times,  to  get  back  as  fast  as  possible  out  of  it 
into  health,  and  regard  that  as  the  real  equilibrium  and 
center  of  things." 

How  clearly  the  virtue  and  also  the  vice  of  the 
deductionist  type  of  intellect  is  seen  in  these  words. 
The  subjective  experience  carried  over  as  a  general 
rule  and  demand !  But  how  infinitely  pathetic !  And 
also  how  instructive  to  those  who  are  now  seeking  to 
unite  the  two  methods  of  intellectual  activity,  deduc- 
tion, and  induction,  in  one  fused  flame  of  philosophic 
science.  The  earnest  woeful  pleading  to  read  books, 
and  to  look  above  all  things  to  the  health,  by  one  who 
had  never  committed  a  conscious  hygienic  sin  in  his 
life,  and  who  had  looked  most  carefully  after  his  health 
every  instant  almost,  of  his  whole  life !  And  yet,  who 
had  suffered  as  great  physical  and  mental  anguish 
from  ill-health  as  ever  mortal  did !  What  every  one  of 
his  hearers  needed  and  what  millions  of  others  still 


76  BIOGRAPHIC    CLINICS. 

need  to  be  told  is  not  to  care  for  their  health,  but  how 
to  do  it.  That  Carlyle  had  never  once  seriously  con- 
sidered; only  an  enlightened  science,  an  enlightened 
medical  science  can  teach  that.  Alas  that  Carlyle  cared 
for  neither !  The  more  imperative  is  our  own  duty. 


CHARLES    DARWIN. 


77 


CHAPTER  III. 

CHARLES   DARWIN. 

The  following  quotations  and  epitomizations  of  the 
data  of  Darwin's  life  are  drawn  from  "  The  Life  and 
Letters  "  by  his  son : 

Charles  Darwin's  father  was  a  highly  successful  physician, 
six  feet  two  inches  tall,  very  corpulent,  with  close  powers  of 
observation,  and  of  sympathy.  He  at  first  hated  his  profes- 
sion, but  practised  it  for  sixty  years,  although  he  had  a  horror 
of  operations,  or  even  to  see  a  person  bled.  This  same  horror 
existed  in  Charles.  Modern  physicians  may  to-day  read  with 
profit  what  Charles  writes  of  his  father  as  a  physician. 

The  health  of  his  brother  Erasmus  was  "  weak  from  boy- 
hood and  he  failed  in  energy."  "  His  spirits  were  not  high, 
sometimes  low,  more  specially  during  early  and  middle  man- 
hood." "  He  read  much,  even  whilst  a  boy."  "  Our  tastes 
were  so  different." 

Charles  Darwin  was  born  February  12,  1809. 

He  was  a  fleet  runner  as  a  boy  at  school,  and  loved  long 
walks ;  his  father  once  said  to  him :  "  You  care  for  nothing 
but  shooting,  dogs,  and  rat-catching,  and  you  will  be  a  dis- 
grace to  yourself  and  all  your  family." 

He  had  great  love  of  poetry  and  music  while  young,  which 
entirely  disappeared  before  he  was  old. 

He  did  "  no  good  "  at  school,  and  was  taken  away  to  Edin- 
burgh, to  study  medicine;  but  he  hated  it,  could  not  dissect, 
detested  the  lectures,  and  could  not  endure  to  see  an  opera- 
tion. After  two  sessions  there,  as  he  seemed  bound  to  be  "  an 
idle   sporting  man"   his   father   proposed  that   he  become  a 

79 


8o  BIOGRAPHIC    CLINICS. 

clergyman.  This  plan  finally  "  died  a  natural  death  "  in  both 
their  minds,  and,  after  spending  three  "  wasted "  years  at 
Cambridge,  he  joined  The  Beagle  as  naturalist. 

The  three  years  at  Cambridge,  "  worse  than  wasted "  in 
shooting,  hunting,  riding,  and  sporting,  were  the  most  joyful 
in  his  life,  because  he  was  in  excellent  health  and  high  spirits. 

When  he  was  compelled  to  do  some  reading,  it  had  the 
result  of  making  him  "  have  spirits  for  nothing." 

"  I  am  so  disgusted  by  reading  that  I  have  not  the  heart  to 
write  anybody."     (Aged  20.) 

"  Reading  makes  me  quite  desperate."     (Aged  21.) 

"  I  do  not  know  why  the  degree  should  make  one  so  miser- 
able, both  before  and  afterwards.  What  makes  it  more  ridicu- 
lous is  I  know  not  what  about."     (22.) 

The  Beagle  voyage  began  December  27,  1831,  and  ended 
October  2,  1836. 

While  waiting  two  months  at  Plymouth  for  the  departure 
during  bad  weather,  he  was  inexpressibly  gloomy  and  miser- 
able, and  troubled  with  pain  and  palpitation  about  the  heart. 
(22.) 

"  We  worked  together  for  several  years  at  the  same  table 
in  the  poop  cabin  of  the  Beagle,  he  with  his  microscope,  and 
myself  at  the  charts.  He  suffered  greatly  from  sea-sickness. 
After  perhaps  an  hour's  work  he  would  say  to  me,  *  Old 
fellow,  I  must  take  the  horizontal  for  it.'  A  stretch  out  on 
one  side  of  the  table  for  some  time  would  enable  him  to 
resume  his  labors  for  awhile,  when  he  had  again  to  lie  down." 
(Admiral  Lord  Stokes,  The  Times,  April,  1883.) 

"  He  was  a  dreadful  sufferer  from  sea-sickness,  and  at  times 
when  I  have  been  officer  of  the  watch,  and  reduced  the  sails, 
making  the  ship  more  easy  and  thus  relieving  him,  I  have 
been  pronounced  by  him  to  be  'a  good  officer'  and  he  would 
resume  his  microscopic  observations  in  the  poop  cabin."  (A. 
B.  Usborne.) 

"  He  was  habitually  in  full  vigor.  ...  He  had,  however, 
one  severe  illness  in  South  America.  ...  I  have  heard  him 


CHARLES   DARWIN.  8i 

say  that  in  this  illness,  every  secretion  of  the  body  was 
affected,  and  that  when  he  described  the  symptoms  to  his 
father,  Dr.  Darwin  could  make  no  guess  as  to  the  nature  of 
the  diseases.  My  father  was  sometimes  inclined  to  think  that 
the  breaking  up  of  his  health  was  to  some  extent  due  to  this 
attack."     (His  son.) 

"It  has  been  assumed  that  his  ill-health  in  later  years  was 
due  to  his  having  suffered  so  much  from  sea-sickness.  This 
he  did  not  himself  believe,  but  rather  ascribed  his  bad  health 
to  the  hereditary  fault  which  came  out  as  gout  in  some  of  the 
past  generations.  I  am  not  quite  clear  as  to  how  much  he 
actually  suffered  from  sea-sickness;  my  impression  is  distinct 
that,  according  to  his  own  memory,  he  was  not  actually  ill 
after  the  first  three  weeks,  but  constantly  uncomfortable  when 
the  vessel  pitched  at  all  heavily.  But,  judging  from  his 
letters,  and  from  the  evidence  of  some  of  the  ofiEicers,  it  would 
seem  that  in  later  years  he  forgot  the  extent  of  the  discom- 
fort from  which  he  suffered."     (His  son.) 

"  I  am  quite  well  again  after  being  in  bed  for  a  fortnight." 
(25.) 

"  It  is  lucky  for  me  that  the  voyage  is  drawing  to  a  close, 
for  I  positively  suffer  more  from  sea-sickness  now  than  three 
years  ago."     (27.) 

From  1836  to  1842  (when  he  settled  at  Down  because  of 
his  ill-health)  he  lived  at  London  and  at  Cambridge.  The 
period  is  marked  by  "  the  gradual  appearance  of  that  weak- 
ness of  health,"  the  "  bitter  mortification "  of  it,  its  "  per- 
manency," the  learning  of  the  narrowness  of  the  limit  of  his 
working  ability,  etc.     (27  to  33.) 

In  1837  he  had  an  attack  of  uncomfortable  palpitation  of 
the  heart.  The  doctors  advised  knocking  off  work  and  living 
in  the  country.  Dr.  Clark  urged  "  giving  up  entirely  all 
writing,  and  even  correcting  press  for  some  weeks."     (28.) 

Work  brings  on  ill-health  in  1838,  and  a  three  days'  holiday 
trip  to  Cambridge  did  him  "  such  wonderful  good "  and 
"filled  his  limbs  with  such  elasticity."     (29.) 


82  BIOGRAPHIC    CLINICS. 

"  I  am  coming  into  your  way,"  he  writes  to  Lyell,*  "  of  only 
working  about  two  hours  at  a  spell ;  I  then  go  out  and  do  my 
business  in  the  streets,  return  and  set  to  work  again,  and  thus 
make  two  separate  days  out  of  one.  The  new  plan  works 
capitally."     (Ibid.) 

"I  worked  as  hard  as  I  possibly  could  (1839-1842)  but  had 
frequently  recurring  unwcllness  and  one  long  and  serious 
illness."     (30  to  33.) 

"I  could  collect  facts  bearing  upon  the  origin  of  species 
when  I  could  do  nothing  else  from  illness."     (Ibid.) 

Ill-health  increases  in  1839,  the  holidays  become  more 
frequent  and  longer;  at  one  time  a  "thirteen  months'  inter- 
val."    (30.) 

"Read  a  little,  was  much  unwell,  and  scandalously  idle." 
(Ibid.) 

"The  entries  of  ill-health  increase  in  number  during  these 
years,  the  holidays  longer  and  more  frequent."     (30-33-) 

"  I  have  been  steadily  gaining  ground,  and  really  believe 
now  I  shall  some  day  be  quite  strong.  I  write  daily  for  a 
couple  of  hours,  and  take  a  little  walk  or  ride  every  day.  I 
grow  very  tired  in  the  evenings."     (32.) 

"Wearisome  drives."     (33.) 

"It  was  the  last  time  I  was  ever  strong  enough  to  climb 
mountains,  or  to  take  long  walks  such  as  are  necessary  for 
geological  work."    (33.) 

"I  manage  only  a  couple  of  hours  a  day  (writing)  and  that 
not  very  regularly."     (34.) 

"I  have  not  had  one  whole  day,  or  rather  night,  without 
my  stomach  having  been  greatly  disordered  during  the  last 
three  years,  and  most  days  great  prostration  of  strength." 
(36.) 

"  Many  of  my  friends,  I  believe,  think  me  a  hypochondriac." 
"  Although  strong  corporeally,  he  cannot  stand  mental  fatigue, 
and  must  have  silence  after  dinner."     (36.) 

"I  therefore  write  this  in  case  of  my  sudden  death,  as  my 
most  solemn  and  last  request,"  etc.     (36.) 

^Thcn  Lyell  probably  had  eye-strain  too. 


CHARLES    DARWIN.  83 

"I  have  of  late  been  slaving  (writing)  extra  hard,  to  the 
great  discomfiture  of  wretched  digestive  organs."     (35  or  36.) 

"  Short  intervals  of  good  health  that  followed  the  long  ill- 
nesses, which  often  times  rendered  life  a  burden  to  him 
between  1844  and  1847."     (Sir  J.  Hooker.) 

"  My  little  ten-day  tour  made  me  feel  wonderfully  strong 
at  the  time,  but  the  good  effects  did  not  last."     (36.) 

"  I  have  been  prevented  from  writing  by  being  unwell,  .  .  . 
abominable  press  work."     (37.) 

"We  go  to  Southampton  if  my  courage  and  stomach  do 
not  fail."     (37.) 

"  Almost  continually  unwell."  "  In  bed  nearly  all  Friday 
and  Saturday."     (38.) 

"Very  unwell,  incapable  of  doing  anything."     (38.) 

"All  this  winter  I  have  been  bad  enough,  .  .  .  my  nervous 
system  began  to  be  affected,  so  that  my  hands  trembled,  and 
my  head  was  often  swimming.  I  was  not  able  to  do  anything 
one  day  out  of  three."     (Ibid.) 

"  Health  very  bad,  with  much  sickness  and  failure  of 
power.  Worked  on  well  days.  The  water-cure  has  most 
extraordinary  effect  in  producing  indolence  and  stagnation  of 
mind.  I  now  increase  in  weight;  have  escaped  sickness  for 
thirty  days."     (40.) 

"  Every  one  tells  me,"  writes  Darwin  in  1849,  "  that  I  look 
quite  blooming  and  beautiful,  and  most  think  I  am  shamming, 
but  you  have  never  been  one  of  those."  His  son  adds :  "  And 
it  must  be  remembered  that  at  this  time  he  was  miserably  ill, 
far  worse  than  in  later  years."     (40.) 

He  got  Dr.  Gully's  book  (on  the  water-cure)  and  goes  with 
the  entire  family  to  Dr.  Gully's  establishment.  "Dr.  Gully 
feels  pretty  sure  he  can  do  me  good,  which  most  certainly  the 
regular  doctors  could  not."     (40.) 

"  It  is  a  sad  flaw  in  my  beloved  Gully  that  he  believes  in 
everything.  When  Miss  was  very  ill,  he  had  a  clair- 
voyant girl  to  report  on  internal  changes,  a  mesmerist  to  put 

her  to  sleep — an  homeopathist,  viz.,  Dr.  ,  and  himself  as 

hydropathist,  and  the  girl  recovered."     (41.) 


84  BIOGRAPHIC    CLINICS. 

He  keeps  up  the  water-cure  at  home  and  thinks  he  is  better 
as  the  months  go  on. 

"  I  am  allowed  to  work  now  two  and  a  half  hours  daily, 
and  I  find  it  as  much  as  I  can  do;  for  the  cold  water-cure 
together  with  three  short  walks  is  curiously  exhausting,  and 
I  am  actually  forced  to  go  to  bed  at  eight  o'clock  completely 
tired.  I  steadily  gain  in  weight,  and  am  never  oppressed  by 
my  food.  I  have  lost  the  involuntary  twitching  of  the 
muscles,  and  all  the  fainting  feelings,  etc.,  black  spots  before 
my  eyes,  etc.  Dr.  Gully  thinks  he  shall  quite  cure  me  in  six 
or  nine  months  more.  The  greatest  bore  which  I  find  in  the 
water-cure  is  the  having  been  compelled  to  give  up  all  read- 
ing, except  the  newspapers.  For  my  daily  two  and  a  half 
hours  at  the  barnacles  is  fully  as  much  as  I  can  do  of  any- 
thing which  occupies  the  mind;  I  am  consequently  terribly 
behind  in  all   scientific  books."     (40.) 

"  I  dread  going  anywhere  on  account  of  my  stomach  so 
easily  failing  under  any  excitement."  "  My  nights  are  always 
bad."  He  takes  the  water-cure,  five  or  six  weeks  of  treatment 
every  two  or  three  months,  "  always  with  good  effect."     (43.) 

He  is  constantly  dreading  "hereditary  ill-health"  for  his 
children.    "  Even  death  is  better  for  them."     (Ibid.) 

"The  other  day  I  went  to  London  and  back,  and  the 
fatigue,  though  so  trifling,  brought  on  my  bad  form  of  vomit- 
ing."    (Ibid.) 

"  My  stomach  has  much  deadened  my  former  pure  enthu- 
siasm for  science  and  knowledge."     (45.) 

There  were  several  visits  to  water  cure  establishments 
from  1856  to  1858.  "I  cannot  in  the  least  understand  how 
hydropathy  can  act  as  it  certainly  does  on  me.  It  dulls  one's 
brain  splendidly."     (48.) 

"  As  usual,  hydropathy  has  made  a  man  of  me  for  a  short 
time."     (49.) 

"  I  have  come  here  for  a  fortnight's  hydropathy,  as  my 
stomach  has  got,  from  steady  work,  into  a  horrid  state." 
(Ibid.) 


CHARLES   DARWIN.  85 

■'  Nor  has  my  stomach  recovered  from  all  our  troubles." 
{Ihid.) 

"  I  pass  my  time  by  doing  daily  a  couple  of  hours  of  my 
abstract."     {Ibid.) 

"  I  am  quite  knocked  up,,  and  am  going  next  Monday  to 
revive  under  water-cure."     {Ibid.) 

"  So  poorly,"  "  health  so  poor,"  "  health  so  wretched  of  late, 
and  has  incapacitated  me  for  everything,"  "  I  am  weary  of 
my  work."     (50.) 

"It  is  a  very  odd  thing  that  I  have  no  sensation  that  I 
overwork  my  brain;  but  facts  compel  me  to  conclude  that 
my  brain  was  never  formed  for  much  thinking."     {Ibid.) 

"  My  health  has  quite  failed.  I  am  off  to-morrow  for  a 
week  of  hydropathy.  I  am  very  sorry  to  say  that  I  cannot 
look  over  any  proofs  in  the  week."     {Ibid.) 

"  Two  chapters  in  type,  and  though  not  yet  corrected,  I  am 
so  wearied  out  and  weak  in  health  that  I  am  resolved  not  to 
add  one  word,  but  merely  to  improve  the  style."     {Ibid.) 

"  I  have  corrected  one  hundred  and  thirty  pages ;  I  long  to 
finish,  for  I  am  nearly  worn  out."     {Ibid.) 

"  I  have  corrected  all  but  the  last  two  chapters —  .  .  .  my 
health  has  been  very  bad,  and  I  am  becoming  as  weak  as  a 
child,  and  incapable  of  doing  anything  whatever  except  my 
three  hours'  daily  work  at  proof  sheets.  .  .  .  Long  fit  of  sick- 
ness yesterday.  It  is  so  weariful  killing  the  whole  afternoon, 
after  12  o'clock  doing  nothing  whatever."     {Ibid.) 

"  I  intend,  if  I  can  keep  to  my  resolution,  of  being  idle  this 
winter.  But  I  fear  ennui  will  be  as  bad  as  a  bad  stomach." 
{Ibid.) 

The  complaints  were  never  so  bitter  and  frequent  as  now 
during  the  work  of  getting  the  abstract  made  and  proofs 
through  the  press  of  his  "  Origin."  "  Before  starting  here 
(hydropathic  establishment)  I  was  in  an  awful  state  of 
stomach,  strength,  temper,  and  spirits."  "  My  confounded 
book  nearly  killed  me."  "  I  am  here  hydropathizing  and 
coming  to  life,  after  having  finished  my  accursed  book."  "  It 
is  astonishing  how  idle  a  three  weeks  I  have  passed."     {Ibid.) 


86  BIOGRAPHIC    CLINICS. 

Concerning  the  general  life  at  Down,  his  son  says  that 
"  indoors  he  sometimes  used  an  oak  stick,  and  this  was  a 
sign  that  he  felt  giddiness."  He  rose  early,  after  his  always 
bad  nights,  walked  before  breakfast,  and  the  one  and  a  half 
hours  after  breakfast  was  his  best  working  time.  He  was 
then  read  aloud  to,  and  then  from  10:30  to  about  12  he  was 
able  to  work  some  more  with  his  eyes.  His  day's  work  was 
then  over. 

"With  regard  to  the  Sand- walk"  (a  walk  about  a  one-and- 
a-half-acre  plot  of  land)  "  in  connection  with  my  father,  my 
earliest  recollections  coincide  with  my  latest.  We  continually 
saw  my  father  as  he  walked  around." 

"I  think  the  newspaper  was  the  only  non-scientific  matter 
which  he  read  to  himself.  Everything  else,  novels,  travels, 
history,   was   read  aloud  to  him." 

"In  the  evening  after  he  had  read  as  much  as  his  strength 
would  allow,  and  before  the  reading  aloud  began  " — 

"  German  was  a  great  labor  to  him ;  in  reading  it  he  could 
read  very  little  at  a  time.     He  called  it  the  Verdammte." 

"Anything  attempted  beyond  the  regular  routine  was 
attended   with  pain  and   difficulty." 

"  He  was  generally  persuaded  by  my  mother  to  take  these 
short  holidays,  when  it  became  clear  from  the  frequency  of 
bad  days,  or  from  swimming  of  his  head,  that  he  was  being 
overworked." 

"  He  thought  the  water-cure  was  a  cure  for  his  troubles, 
but  like  all  other  remedies,  it  had  only  a  transient  effect  on 
him." 

After  the  completion  of  the  hard  task  of  putting  the 
"  Origin "  through  the  press,  he  "  could  hardly  sit  up "  and 
found  that  two  or  three  months  at  Ilkley  this  time  "  did  him 
no  essential  good."  The  doctor  had  told  him  this  would  be  a 
"  unique  crisis."  "  Now,  under  water-cure,  with  all  nervous 
power  directed  to  the  skin,  I  can  possibly  do  no  head  work." 
(50.) 

"  I  have  been  poorly  with  almost  continual  bad  headache 


CHARLES   DARWIN.  87 

for  forty-eight  hours,  and  I  was  low  enough,  and  thinking 
what  a  useless  burden  I  was  to  myself  and  others."    (51.) 

In  1863  began  a  six  months'  illness;  he  remained  ill  and 
depressed  despite  the  hopeful  opinion  of  one  of  the  most 
cheery  and  skilful  physicians  of  the  day.  "  He  (the  physi- 
cian) does  not  believe  my  brain  or  heart  are  primarily 
affected."     (54.) 

In  1864  "  his  health  took  a  turn  for  the  better  "  and  he  was 
able  to  do  not  more  than  one  and  a  half  hours*  work  on  his 
best  days.  "  My  brain  feels  far  stronger,  and  I  have  lost 
many  dreadful  sensations."     (55.) 

In  1865  there  was  again  ill-health,  but  towards  the  close  of 
the  year  he  began  to  recover  under  the  care  of  the  late  Dr. 
Bence- Jones  who  dieted  him  severely.     (56.) 

Even  scientific  books  were  now  read  aloud  to  him.     (Ibid.) 

"  It  is  a  horrid  evil  for  me  that  I  can  read  hardly  anything, 
for  it  makes  my  head  almost  immediately  begin  to  sing 
violently."     (Ibid.) 

His  health  improved  in  1866,  and  he  can  work  one  or  two 
hours  a  day.     (57.) 

"  Science  makes  him  forget  for  some  hours  every  day  his 
accursed  stomach."     (59.) 

Health  grows  better  in  1870.     (61.) 

During  the  last  ten  years  of  his  life,  the  condition  of  his 
health  was  a  cause  of  satisfaction  and  hope  to  his  family. 
His  condition  showed  signs  of  amendment  in  several  par- 
ticulars. He  suffered  less  distress  and  discomfort,  and  was 
able  to  work  more  steadily. 

In  later  years  he  became  a  patient  of  Sir  Andrew  Clark, 
under  whose  care  he  improved  greatly  in  general  health.  It 
is  certain  that  he  had  no  serious  and  permanent  trouble  of 
his  heart  until  shortly  before  his  death. 

He  died  in  1882,  aged  73,  of  heart  disease,  angina  pectoris, 
atheromatous  and  senile  heart  changes. 

"  For  nearly  forty  years  he  never  knew  one  day  of  health 
of  ordinary  men,  and  thus  his  life  was  one  long  struggle  of 
the  weariness  and  strain  of  sickness."     (His  son.) 


88  BIOGRAPHIC    CLINICS. 

The  Influence  of  Eye-Strain  upon  Character  and 
Life. — In  the  article  upon  De  Quincey,  I  spoke  of  the 
psychologic  influence  of  errors  of  refraction,  the  power- 
ful and  subtle  effect  of  eye-strain  in  the  developing  boy 
upon  the  character  or  disposition,  the  choice  of  a 
career,  etc.  I  found  reason  to  believe  that  this  factor 
had  been  at  work  in  De  Quincey's  case,  as  the  unrecog- 
nized cause  of  the  seven  years'  vagabondage  of  the 
unequalled  scholar.  It  was  the  only  way  the  wisdom 
of  the  organism  could  devise  to  rid  itself  of  the  pro- 
found injury  which  reading  and  writing  was  causing 
the  nervous  and  digestive  systems.  It  even  made  the 
evil  of  the  opium  habit  preferable  to  the  unbroken 
impact  of  the  ocular  irritation.  To  such  a  mind  as  that 
of  De  Quincey,  the  literary  career  could  not  be  escaped, 
and  so  there  was  the  life-long  tragedy  we  have 
witnessed. 

In  Carlyle's  case  the  dour  Scotch  inheritance,  body 
and  mind,  together  with  physical  work,  country  Hfe, 
and  an  absence  of  an  enslaving  literary  ambition,  made 
him  miss  the  evil  effects  of  eye-strain  during  youth; 
but  from  the  age  of  23  onward  the  conditions  (reading 
and  writing)  of  the  chosen  career  made  him  a  great 
sufferer  so  long  as  there  was  any  ocular  "  accommoda- 
tion "  left.  As  Mrs.  Carlyle  said  there  would  have  been 
no  "tongues "  if  Irving  had  married  her,  so  there 
would  have  been  no  vagabondage  and  no  opium  in  De 
Quincey's  case  if  he  had  chosen  the  career  of  a  farmer ; 


CHARLES   DARWIN.  89 

and  if  Carlyle  had  chosen  his  father's  occupation  there 
would  have  been  as  utter  absence  of  the  misery  of  his 
life  and  the  peculiar  qualities  of  "  history  by  lightning- 
flashes." 

When  we  come  to  Darwin,  we  find  the  same  causes 
producing  the  same  results,  but  with  the  diiferences  of 
detail  which  all  biologic,  and  especially  all  psychologic, 
phenomena  exhibit.  For,  be  he  oculist,  general  physi- 
cian or  intelligent  layman,  when  one  reads  the  life  and 
letters  of  Darwin,  he  must  be  struck  with  the  aston- 
ishing fact  of  the  strangeness  and  illogicality  of  the 
life  of  the  great  scientist's  youth.  Up  to  the  age  of  22 
he  had  done  nothing  but  waste,  "  worse  than  waste," 
time  and  opportunity  in  hunting,  walking,  riding, 
athletics,  rat-catching,  with  dogs,  etc.,  so  that  even  his 
most  kind  and  indulgent  father  said  he  would  be  a 
disgrace  to  himself  and  to  his  family.  Medicine  could 
not  attract  the  attention  of  the  "  idle  sporting  man  " 
and  also  the  function  of  clergyman  had  no  charm. 
Why?  Because  he  was  in  excellent  health  and  high 
spirits  when  he  did  not  use  his  eyes  at  near  range,  but 
any  reading  made  him  "  have  spirits  for  nothing," 
made  him  "  so  disgusted  that  he  had  not  the  heart  to 
write  anybody  ", — made  him  *'  quite  desperate."  The 
degree  at  Cambridge  caused  him  to  become  "  so  miser- 
able, both  before  and  afterward,"  and,  ''  what  makes  it 
more  ridiculous,  I  know  not  what  about."  Once  at  the 
age  of  22,  he  was  for  two  months  compelled  by  bad 
7 


90  BIOGRAPHIC    CLINICS. 

weather  to  keep  indoors  in  a  strange  place,  without 
friends,  and  without  amusements  other  than  reading, 
and  he  was  "  inexpressibly  gloomy  and  miserable,"  and 
even  troubled  with  pain  and  palpitation  about  the 
heart.^  The  simple  recital  of  facts  compels  one  to 
recognize  that  the  wasted  years  of  Darwin's  youth  were 
not  "  worse  than  wasted  "  by  choice ;  it  was  not  because 
of  the  compulsion  of  inherent  mental  tendencies,  nor  of 
fashion,  nor  because  of  his  dislike  of  classic  studies. 
There  was  nothing  in  his  ancestry  nor  in  his  life-work 
of  after  years  that  would  force  him  to  such  amuse- 
ments and  to  the  escape  of  all  study ;  there  were  plenty 
of  earnest  men  at  Cambridge,  there  was  opportunity 
for  congenial  study — if  study  of  any  kind  had  been 
possible,  and  health  retained.  There  was  no  way  to  a 
serious  and  honorable  life,  was  the  unconscious  com- 
mand of  the  wisdom  of  the  organism,  except  perhaps 
through  some  such  a  plan  as  the  Beagle  voyage.  Thus 
science  gained  its  martyr,  although  he  did  not  know, 
and  indeed  he  never  knew,  the  exact  nature  of  the 
cause  of  his  martyrdom. 

As  to  Darwin's  Sea-Sickness. — A  careful  reading 
of  notes  I  have  collated  as  to  Darwin's  sea-sickness  are 
quizzically  puzzling.     From  his  study  of  the  case  his 

*  Similar  symptoms  were  also  complained  of  by  Carlyle  and 
Huxley.  It  was  purely  functional.  Extreme  eye-strain  will 
sometimes  cause  such  signs  of  cardiac  irritation,  as  has  been 
noted  by  oculists. 


CHARLES   DARWIN.  9^ 

son  concludes  in  a  state  of  inconclusion  as  to  the  sever- 
ity, continuance,  and  even  actuality  of  the  suffering 
from  sea-sickness,  especially  after  the  first  three  weeks. 
This  strikes  one  as  very  strange.  According  to  the 
testimony  of  the  rest  of  us,  genuine  sea-sickness  is  not 
unrecognized  and  never  forgotten  by  one  who  has 
endured  it.  This  haziness  of  Darwin's  own  mind  and 
memory  upon  the  subject  is  illuminating,  particularly 
if  we  remember  that  he  says  in  1836  towards  the  end 
of  the  voyage,  that  he  "  positively  suffers  more  from 
sea- sickness  than  he  did  three  years  ago  "  and  that  he 
is  therefore  glad  it  is  about  over.  Even  here  there  is 
an  amusing  inexactness.  As  the  voyage  began  two 
years  more  than  "  three  years  ago  "  when  he  had  the 
"  actual  "  illness  of  three  weeks.  It  is  highly  probable 
that  the  greater  "  sea-sickness  "  towards  the  end  of  the 
voyage  was  due  to  the  fact  that  he  was  far  more  occu- 
pied with  his  journals  and  records,  writing  more  in 
order  to  put  his  experiences  in  literary  order,  making 
up  for  lost  time,  etc.,  prior  to  disembarking.  One  finds 
a  clue  through  this  odd  sort  of  fog  or  haze,  and  begins 
to  understand  these  peculiar  contradictions,  when  he 
notes  Admiral  Lord  Stokes'  description  of  the  actual 
facts.  When  working  with  his  microscope,  Darwin 
was  not  putting  his  eyes  to  the  strain  they  would  suffer 
when  reading  or  writing,  and  yet,  at  this  early  age,  and 
with  this  slight  strain,  even  an  hour's  work  compelled 
him  to  "  take  the  horizontal  for  it,"  and  a  "stretch  out 


92  BIOGRAPHIC    CLINICS. 

upon  the  table  for  some  time  would  enable  him  to 
resume  his  labors  for  awhile,  when  he  had  to  lie  down 
again."  One  smiles  cynically  at  an  old  sailor  like 
Stokes,  who  calls  that  "  suffering  greatly  from  sea- 
sickness." I  never  yet  saw  one  downright  ill  with  that 
malign  mal  who  could  get  relief  by  lying  down  on  a 
table  for  a  little  while,  and,  thus,  repeatedly,  be  enabled 
to  resume  intellectual  labor.  Plainly,  Darwin's  sea- 
sickness on  the  Beagle  voyage  was  the  same  nausea 
and  morbid  nervous  symptoms  that  thousands  of 
patients  have  described  to  their  oculists,  as  following 
use  of  the  eyes  without  the  proper  spectacles,  and  dis- 
appearing at  once,  the  moment  all  use  of  the  eyes  is 
stopped.  Darwin  had  found  great  discomfort  during 
his  youth  and  up  to  22,  upon  the  use  of  his  eyes ;  it  was 
more  pronounced  and  intense  now  during  the  voyage 
(some  slight  sea-sickness  cooperating)  ;  and,  in  the 
productive  years  of  his  after  Hfe,  from  the  ages  of 
about  40  to  about  60,  it  was  a  daily  tragedy  and  horror. 
Is  it  not  at  once  clear  from  all  the  symptoms  and  the 
accounts  given  that  it  was  not  true  sea-sickness  that 
was  the  chief  trouble  experienced  by  Darwin  during 
the  voyage;  that  during  the  time  Darwin  himself  and 
others  said  that  it  was  this  affection ;  that  in  after  years, 
Darwin  was  in  great  doubt  about  it;  and  that  his  re- 
ports made  more  problematic  the  nature  of  the  malady  ? 
Moreover,  he  had  little  of  this  problematic  affection, 
according  to  some  of  his  statements,  after  the  first  three 


CHARLES   DARWIN.  93 

weeks.  It  was  of  course  natural  that  the  vomiting  he 
had  aboard  ship  should  be  called  sea-sickness,  but  he 
had  it  for  thirty  years  afterward,  and  the  cause  of  it 
was  probably  the  same  both  on  ship  and  shore.  It  is 
also  as  natural  that  there  should  afterward  be  much 
confusion  and  indecision  in  Darwin's  mind  as  to  the 
very  existence  of  true  sea-sickness,  when  he  found  pre- 
cisely the  same  symptoms  continuing  throughout  the 
greater  part  of  his  life.  If  his  vomiting  was  due  to 
eye-strain,  all  the  haze  and  discrepancy  disappear  and 
the  matter  stands  clear.  Why,  it  may  be  asked,  did  he 
not  have  the  symptom  more  constantly  when  on  board 
the  B eagle  f  Because,  if  the  expression  is  allowable,  he 
was  younger  than  when  he  was  ten  or  twenty  years 
older ;  i.  e.,  he  was  more  resistant,  and  he  reacted  more 
quickly;  but  the  chief  reason  is  that  comparatively  he 
did  little  or  no  reading  and  writing  there.  It  is  true, 
as  his  son  says,  that  "  the  amount  of  work  that  he  got 
through  on  the  Beagle  shows  that  he  was  habitually  in 
full  vigor,"  but  his  time  was  occupied  almost  entirely 
with  geologizing,  botanizing,  collecting  specimens,  and 
long  trips  and  stays  ashore,  and  with  the  microscope, 
and  probably  with  "  the  horizontal "  and  idling  when 
sailing.  There  was  no  pressing  duty  of  writing  or 
reading,  and  indeed  little  occasion  for  either,  so  that 
whenever  he  felt  ill  during  the  little  desultory  reading 
he  did,  he  could  at  once  drop  it  and  "take  the  hori- 
zontal for  it "  or  lounge  about  deck.    It  was  different 


94  BIOGRAPHIC    CLINICS. 

in  after  life,  although  at  best,  and  whatever  the  in- 
centive, he  could  never  do  but  two  or  three  hours'  work 
a  day. 

There  is  a  striking  confirmation  of  the  view  I  have 
intimated,  and  one  that  shows  Darwin  to  have  been 
singularly  resistant  to  genuine  and  uncomplicated  sea- 
sickness. In  1838,  between  one  and  two  years  after  the 
end  of  the  Beagle  voyage,  Darwin  went  to  Scotland 
(on  a  holiday  for  bad  health)  by  steampacket  to  Edin- 
burgh.   Upon  his  return  he  wrote  to  Lyell : 

"  My  trip  in  the  steampacket  was  absolutely  pleasant,  and 
I  enjoyed  the  spectacle,  wretch  that  I  am,  of  two  ladies  and 
some  small  children  quite  sea-sick,  I  being  well.  Moreover, 
on  my  return  from  Glasgow  to  Liverpool,  I  triumphed  in  a 
similar  manner  over  some  full-grown  men." 

He  was  geologizing  and  not  reading,  writing,  or  even 
using  the  microscope.  It  seems  evident,  therefore, 
that  at  best  the  Beagle  "  sea-sickness ''  except  perhaps 
during  the  first  three  weeks,  was  not  due  to  the  ship's 
motion,  but  rather  to  the  same  cause  that  produced  the 
nausea,  etc.,  in  after  years. 

The  Severe  Illness  in  South  America. — Although 
"  habitually  in  full  vigor  "  during  the  Beagle  voyage 
(with  the  exception  of  the  reflex  neuroses  due  to  the 
use  of  the  eyes  with  the  microscope,  etc.),  Darwin  had 
one  "  severe  illness  "  of  so  strange  a  type  that  "  every 
secretion  of  the  body  was  affected."  When  the  symp- 
toms were  described  to  Darwin's  father,  he  "  could 


CHARLES   DARWIN.  95 

make  no  guess  as  to  the  real  nature  of  the  disease."  If 
we  knew  accurately,  instead  of  knowing  nothing  of  the 
actual  life  of  Darwin  during  the  weeks  or  even  days, 
before  the  seizure,  we  should,  I  doubt  not,  find  that 
during  some  time  of  forced  bodily  inactivity  severe 
use  of  the  eyes  had  precipitated  the  attack.  If  we 
could  have  far  more  accurate  description  of  all  the 
symptoms  we  could  understand  better  just  what  took 
place,  what  organs  bore  the  brunt  of  the  derouted 
reflex,  what  was  the  morbid  result,  or  what  disease  this 
protean  ocular  "  insult "  led  up  to  or  assumed.  Noth- 
ing better  proves  the  almost  uncanny  inerrancy  of  the 
diagnostic  acumen  of  Darwin's  father  than  his  index- 
ing perception  of  the  possible  unity  and  connection  of 
this  special  attack  with  the  bad  health  of  the  later 
years.  The  adumbration  of  the  truth,  the  mixture  of 
the  truth  and  error,  in  the  passing  remark,  is  of 
especial  suggestiveness. 

The  First  Two  Years  at  Home,  after  the  Beagle 
Voyage. — Darwin  arrived  at  home  October  5,  1836,  in 
most  excellent  health  and  spirits.  He  was  very  soon 
busy  getting  his  specimens  and  collections  off  the 
Beagle,  properly  disposed  of,  unpacked,  etc.  At  this 
time  he  wrote  to  Captain  Fitz-Roy : 

"  However  others  may  look  to  the  Beagle's  voyage,  now 
that  the  small  disagreeable  parts  are  well  nigh  forgotten 
(italics  mine),  /  think  it  far  the  most  fortunate  circumstance 
in  my  life  (italics  are  the  author's)  that  the  chance  afforded 
by  your  offer  of  taking  a  naturalist  fell  on  me." 


96  BIOGRAPHIC    CLINICS. 

On  November  6,  he  wrote : 

"  My  London  visit  has  been  quite  idle  so  far  as  natural  his- 
tory goes,  but  has  been  passed  in  exciting  dissipation  among 
the  dons  of  science.  All  my  afifairs,  indeed,  are  most  pros- 
perous." 

In  March,  1837,  he  wrote: 

"The  only  evil  found  in  Cambridge  was  its  being  too 
pleasant;  there  was  some  agreeable  party  or  other  every  even- 
ing, and  one  can  not  say  one  is  engaged  there  with  so  much 
impunity  as  in  this  great  city." 

The  last  allusion  is  the  first  ominous  sign  we  find  of 
what  he  later  called  "  London  for  smoke,  ill-health,  and 
hard  work."  But  in  October,  one  year  after  the  end 
of  the  Beagle  voyage,  we  have  these  words : 

"I  have  not  been  very  well  of  late,  with  an  uncomfortable 
palpitation  of  the  heart.  .  .  .  When  I  consulted  Dr.  Clark  in 
town  he  at  first  urged  me  to  give  up  entirely  all  writing  and 
even  correcting  press  for  some  weeks." 

He  was  busily  engaged  in  literary  work  on  the 
results  of  his  voyage,  which  he  continued  despite  Dr. 
Clark's  advice.  But  in  May,  1838,  he  was  compelled 
by  his  symptoms  to  stop  work  for  a  holiday  at  Cam- 
bridge. This  he  thoroughly  enjoyed,  and  it  did  him 
*'  such  wonderful  good  and  filled  my  limbs  with  such 
elasticity  that  I  must  get  a  little  work  out  of  my  body 
before  another  holiday." 

But  in  June  he  was  worse  and  had  to  give  up  work 
and  take  the  geologizing  trip  in  Scotland  wherein,  as 


CHARLES   DARWIN.  97 

we  have  seen,  he  was  still  able  to  triumph  over  others 
as  regards  sea-sickness. 

Thus  ends  what  may  be  called  the  period  of  youth 
and  health  of  Darwin's  life.  He  had  escaped  all  the 
disastrous  effects  of  eye-strain  in  boyhood  by  not 
studying  at  all,  by  the  "  waste  and  worse  than  waste  " 
of  his  time,  as  his  father  said,  in  sports.  It  was  a  wise 
waste,  as  we  now  know.  The  same  unconscious  wis- 
dom drove  him  along  "  the  line  of  least  resistance  "  in 
the  study  of  natural  history  and  in  seeking  the  appoint- 
ment of  naturalist  in  the  Beagle  expedition,  during 
which  there  had  been  comparatively  little  use  of  the 
eyes  in  reading  and  writing,  and  much  out-of-door 
activity  of  all  kinds.  By  disuse  of  the  eyes  in  reading 
and  writing  he  therefore  certainly  escaped  the  "  first 
critical  period  "  of  eye-strain  in  boyhood.  The  "  sec- 
ond critical  period  "  he  also  came  near  missing  in  the 
same  way,  but  it  was  represented  by  his  Beagle  sea- 
sickness, and  perhaps  the  strange  illness  in  South 
America.  Certain  it  is  that  he  returned  in  1836  in  per- 
fect health  and  spirits,  full  of  hope  and  ambition,  and 
when  the  short  period  of  "  dissipation  "  was  over,  the 
effects  of  his  plunge  into  work  were  at  first  resisted 
with  remarkable  strength.  The  first  slight  intimation 
of  ill-health  was  in  six  months,  but  in  one  year  it  was 
so  sharp  that  Clark  advised  stopping  all  writing,  proof- 
reading, etc.  In  two  years  after  his  return,  the  en- 
forced holidays  did  little  or  no  permanent  good,  al- 


98  BIOGRAPHIC    CLINICS. 

though  while  taking  place  there  was  immediate  relief; 
the  resiliency  had  not  yet  been  entirely  lost.  Hence- 
forth, however,  the  escape  from  reading  and  writing 
was  impossible  (ah,  that  he  had  tried  dictation  to  an 
amanuensis!)  and  as  the  duty  grew  more  unavoidable 
there  was  also  at  last,  the  growing  handicap  of  pres- 
byopia. 

From  the  Age  of  Twenty-Nine,  to  the  End  of  Ac- 
commodation Failure. — It  is  strange  that  Darwin  him- 
self and  his  physicians  should  have  supposed  that 
intellectual  labor  was  the  cause  of  his  symptoms.  It 
is  true  that  Dr.  Clark  was  accustomed  to  tell  his  literary 
patients  to  quit  proof-reading,  writing,  etc.,  and  take 
a  holiday,  but  this  was  routine,  and  with  the  plain  in- 
tent to  break  up  mental  work,  and  of  course,  infinitely 
far  from  any  consciousness  that  it  was  abnormal  ocular 
function,  instead  of  intellectual  over-exertion  that  was 
at  fault.  Once  Darwin  recognized  this  when  at  the 
age  of  50  he  wrote:  "It  is  a  very  odd  thing  that  I 
have  no  sensation  that  I  overwork  my  brain."  This 
was  when  he  was  hardest  at  work  on  the  "  Origin." 
As  if  thought  and  laborious  intellectual  action  could 
be  stopped  in  De  Quincey,  Carlyle,  Huxley,  or  Darwin 
by  making  them  walk  half  their  lives  or  more  about 
rings,  sand-walks,  or  moors,  or  ride  20,000  miles  on 
one  horse,  etc. !  In  reality  such  things  made  mental 
action  the  greater,  adding  also  worry,  introspection,  the 
regret  of  lost  time,  etc.     Indeed,  Darwin  says  that 


CHARLES   DARWIN.  99 

when  he  could  do  nothing  else  from  illness,  he  could 
collect  his  facts  for  the  "Origin  of  Species."     Cor- 
recting proofs  is  by  no  means  such  intellectual  work 
as  thinking  out  and  composing  the  "Origin  of  Spe- 
cies," and  yet  Darwin  himself  wrote,  "and,  also,  there 
yet  remains  the  worst  part  of  all,  correcting  the  press." 
It  was  worse  because  it  was  more  laborious  to  the  eyes. 
Doubtless  the  splendid  inductive  quality  of  his  mind, 
the  patient  and  tireless  gathering  of  facts  which  dis- 
tinguishes his  books  and  bottoms  them  upon  an  incon- 
trovertible basis,  was  in  great  part  due  to  this,  that 
he  was  unconsciously  compelled  to  spend  his  time  so 
largely  in  some  manner  as  did  not  induce  the  reflexes  i  £ 
of  eye-strain.     In  this  connection  it  is  noteworthy  that  \    '■ 
he  so  early  adopted  the  suggestion  of  Lyell  of  dividing  ! 
the  working  day  into  two  parts,  working  about  two  \ 
hours  at  a  spell,  and  resting  between.     But  nothing  ' 
could  prevent  the  frequently  recurring  "  unwellnesses," 
the  long  and  serious  illnesses,  the  longer  and  more 
frequent  holidays,  one  thirteen  months  long  at  the  age 
of  33>  when  he  congratulates  himself  that  he  can  work 
two  hours  a  day,  etc. 

There  is  one  noteworthy  difference  between  Darwin 
and  all  the  others  we  are  studying  in  this  series.  At 
the  age  of  33  he  regrets  that  he  must  renounce  long 
walks,  mountain-climbing,  etc.,  whereas  the  others 
never  lose  this  kind  of  physical  vigor.  I  think  this 
difference  is  explainable  as  due,  for  the  most  part,  to 


loo  BIOGRAPHIC    CLINICS. 

the  vomiting  from  which  he  suffered.^  This  with 
insomnia  was  his  most  constant  symptom;  the  result- 
ing denutrition  was  great,  and  left  him  with  little 
nerve-force  for  muscular  innervation.  What  little  was 
left  was  further  reduced  by  his  morbid  addiction  to 
hydropathy,  which,  while  it  "  dulled  his  brain  splen- 
didly "  and  rested  his  eyes  a  little,  still,  did  more  harm, 
I  think,  than  good. 

At  36  he  had  not  a  day  or  rather  a  night  for  three 
years  without  great  stomach  disorder,  most  days  with 
great  prostration  of  strength.  He  became  so  alarmed 
that  he  believed  he  should  die,  and  made  "  a  solemn 
and  last  request."  Trembling  of  the  hands  and 
"  swimming "  of  the  head  were  added  to  the  other 
symptoms  in  1838,  whilst  severe  headaches  were  al- 
luded to  at  the  age  of  51.  If  it  was  possible  for  a 
worse  than  usual  to  exist  from  the  age  of  30  to  that 
of  about  57,  it  was  when  he  was  putting  the  "  Origin  " 
through  the  press  at  the  age  of  50.  At  the  completion 
of  that  hurried  work,  he  was  in  a  deplorable  condition. 
I  need  not  repeat  or  recapitulate  the  evidences  of  his 
physical  condition  I  have  partly  gathered  in  the  pre- 
ceding selections.  There  are  a  number  of  indications 
of  the  close  connection  of  ocular  labor  and  the  im- 
mediate   appearance    or    recrudescence    of    systemic 

*  He  dreaded  at  43  to  go  anywhere,  fearing  that  his  stomach 
would  so  easily  fail;  excitement  or  fatigue  would  cause  the 
"bad    form   of   vomiting." 


CHARLES   DARWIN.  loi 

symptoms,  the  exhaustion,  etc.  Reading  at  20  and  21, 
we  remember,  made  him  have  "  spirits  for  nothing," 
"  disgusted  him  so  he  had  not  the  heart  to  write  any- 
body," made  him  "  miserable  before  and  after,"  etc. 
Such  allusions  constantly  recur,  e.  g.,  at  30  he  "  read  a 
little,  was  much  unwell " ;  at  36,  "  slaving  (writing) 
extra  hard  brought  great  discomfiture  of  wretched 
digestive  organs  " ;  at  37  "  abominable  press  work  " 
prevented  him  from  writing,  being  unwell;  at  45,  his 
"  stomach  deadens  his  former  pure  enthusiasm  for 
science  and  knowledge  " ;  at  49  his  stomach  "  got  into 
a  horrid  state  from  overwork  " ;  at  50,  "  health  failed, 
cannot  look  over  any  proofs  " ;  he  is  "  wearied  out," 
"  worn  out,"  "  weak  as  a  child,"  etc.,  with  proof- 
reading. At  the  completion  of  the  "  Origin  "  he  was 
in  an  awful  state  of  stomach,  strength,  temper,  and 
spirits ;   "  my  confounded  book  half-killed  me." 

There  are  several  facts  that  should  be  borne  in  mind 
as  to  all  the  terrible  years  at  Down  and  at  the  hydro- 
pathic establishments: 

1.  He  had  to  give  up  all  extra  reading  and  writing 
except  the  newspapers  whilst  he  was  at  the  water-cure 
establishment,  as  two  and  one  half  hours  at  his  regular 
work  was  all  that  was  allowed,  and  with  the  exhaust- 
ing, brain-dulling  water-cure  he  was  completely  tired 
and  had  to  go  to  bed  at  eight  o'clock,  etc. 

2.  The  compelled  and  tiresome  idleness,  as  he  was 
able  to  work  but  one  and  a  half  to  three  hours  a  day. 


I02  BIOGRAPHIC    CLINICS. 

"  It  is  so  weariful  killing  the  whole  afternoon  after  12 
o'clock  doing  nothing  whatever.  ...  I  intend  if  I  can 
to  keep  my  resolution,  of  being  idle  this  winter.  But, 
I  fear  ennui  will  be  as  bad  as  a  bad  stomach." 

3.  The  necessity  of  exercise  and  its  peculiar  kind — 
the  daily  round  upon  round  of  the  "  sand-walk,"  year 
in,  year  out.  "  In  connection  with  my  father,  my 
earliest  recollections  coincide  with  my  latest.  We  con- 
tinually saw  my  father  as  he  walked  around." 

4.  "  I  think  the  newspaper  was  the  only  non-scien- 
tific matter,"  says  his  son,  "  which  he  read  to  himself. 
Everything  else,  novels,  travel,  history,  was  read  aloud 
to  him." 

5.  The  great  labor  German  was  to  him.  He  could 
read  but  very  little  of  these  "  verdammte  "  eye-weary- 
ing forms  of  letters. 

Each  one  of  these  facts  adds  to  the  cumulative  evi- 
dence that  eye-strain  was  the  fundamental  cause  of 
Darwin's  ill-health. 

The  influence  of  completed  presbyopia  and  the  re- 
markable cessation  of  almost  all  of  the  troublesome 
symptoms  that  had  made  such  a  tragedy  of  his  life,  is 
a  further  proof,  if  needed,  of  the  theory.  In  1866, 
when  he  was  57,  his  health  improved  so  that  he  could 
work  one  or  two  hours  a  day ;  at  the  age  of  59,  "  sci- 
ence makes  him  forget  for  some  hours  his  accursed 
stomach."  From  this  time  on  the  complaints  cease 
almost  entirely ;    in  these  last  years  of  his  life  "  the 


CHARLES    DARWIN.  103 

condition  of  his  health  was  the  cause  of  satisfaction 
and  hope  in  his  family ;  ...  he  was  able  to  work  more 
steadily." 

It  was  plain  that  there  was  no  organic  disease,  and 
that  miost  strangely  there  was  a  sudden  and  apparently 
causeless  cessation  of  the  cause  of  the  afflictions  of  the 
past  thirty  years.  I  do  not  judge  that  this  return  of 
health  was  due  to  the  care  of — any  physician.  The 
loss  of  accommodation  ended  the  life-long  struggle  of 
the  ciliary  muscle  to  overcome  the  compound  hyperopic 
astigmatism  of  his  eyes,  the  existence  of  which  will 
alone  explain  the  mystery  of  Darwin's  ill-health.  His 
symptoms,  vomiting  and  other  functional  digestional 
disorders,  insomnia,  vertigo,  headache,  apathy,  and 
neurasthenia,  are  precisely  those  which  the  best  Ameri- 
can oculists  find  are  the  most  common  symptoms  of 
this  refractive  anomaly  of  the  eyes.  Every  fact  con- 
cerning his  health  and,  indeed,  almost  every  day's  ex- 
perience during  his  life  demonstrated  that  use  of  his 
eyes  at  near  range  produced  these  symptoms. 

The  Literary  Product. — Up  to  the  time  when  Dar- 
win's health  began  to  improve,  i.  e.,  about  1866,  when 
he  .was  57  years  of  age,  he  had  written  five  major  works, 
the  "Naturalist's  Voyage,"  "Coral  Reefs,"  "Origin 
of  Species,"  "  Fertilization  of  Orchids,"  and  "  Move- 
ment in  Plants,"  aggregating,  in  the  edition  I  have, 
about  2,400  pages,  or  an  average  of  writing  of  about 
eight  lines  a  day.     Against  the  five  books  in  thirty 


I04  BIOGRAPHIC    CLINICS. 

years  we  have  eight  books  (omitting  the  "  Life  and 
Letters"),  published  in  the  fifteen  years  from  1867  to 
1882,  and  aggregating  about  3,700  pages,  or  an  aver- 
age more  than  three  times  as  great  as  in  the  former 
period.  As  .with  Carlyle,  the  total  product  averaged 
less  than  one  half-page  a  day.  I  cite  such  figures  only 
as  indicative  of  the  difficulties  under  which  both  men 
worked,  and  not  as  a  suggestion  that  one  page  of  their 
writing  is  not  of  a  thousand  times  the  value  of  those 
of  more  fluent  writers. 

Postscript. — The  foregoing  pages  were  written  ex- 
actly as  they  stand  when  I  turned  to  the  article  (which 
I  had  kept  unread  until  I  should  have  made  my  own 
study)  written  by  Dr.  W.  W.  Johnston,  of  Washing- 
ton, D.  C,  upon  "The  Ill-Health  of  Darwin,"  and 
appearing  in  the  American  Anthropologist,  Vol.  3,  No. 
I,  January-March,  1901.  Dr.  Johnston  emphasizes 
the  following  points : 

1.  The  indefiniteness  and  paucity  of  statements  as  to  the 
health  during  the  voyage,  and  Darwin's  great  powers  of  phys- 
ical endurance. 

2.  He  was  only  "  occasionally  unwell "  for  two  years  and 
three  months  after  his  return. 

3.  "  Frequently  recurring  illness  "  and  "  losing  ground  year 
by  year  "  for  the  next  three  years  until  the  removal  to  Down. 

4.  The  symptoms  and  habits  of  life  as  described. 

5.  "  For  increasing  suffering  there  was  but  one  remedy — a 
complete  abandonment  of  all  writing  and  absence  from  home 
and  study  "  . . .  "  Overwork  or  a  long-continuance  of  moderate 
work  made  him  ill :  rest  from  work  made  him  better." 


CHARLES   DARWIN.  105 

6.  The  marked  change  for  the  better  is  placed  at  63;  the 
relief  for  the  rest  of  his  life. 

7.  "The  discomforts,  fatigues,  and  mental  overstrain  of  the 
Beagle  voyage  can  fairly  be  set  down  as  the  initial  cause  of 
Darwin's  subsequent  invalidism.  .  .  .  When  he  landed  in 
England  his  nervous  system  was  exhausted.  .  .  .  On  arriving 
in  London  ...  he  at  once  began  to  work  as  hard  as  he  pos- 
sibly could,  although  interrupted  by  frequently  recurring  ill- 
nesses, and  one  long  and  serious  illness.  .  .  .  Persistent  over- 
strain. .  .  .  The  necessary  result  of  all  this  was  to  multiply 
many  times  the  original  acquired  exhaustion,  and  to  create  a 
condition  which  was   permanent." 

8.  "  He  lived  a  modified  form  of  rest-treatment  j  ust  such  as 
is  now  advised  for  cases  like  his." 

9.  "  The  alternation  of  work  and  complete  rest  was  essen- 
tial for  his  studies." 

10.  "  Darwin's  disease  was  chronic  neurasthenia  of  a  severe 
grade  due  first  to  the  overstrain  of  the  Beagle  voyage,  and 
second  to  the  life  of  hard  intellectual  work." 

I  regret  to  differ  from  so  eminent  an  authority  and 
excellent  physician  as  Dr.  Johnston,  as  to  the  etiology 
and  diagnosis  in  this  case.  Far  more  do  I  dislike  to 
notice  that  there  is  not  a  particle  of  evidence  for  the 
supposition  that  there  were  any  "  discomforts,  fatigues, 
and  mental  over-strain "  during  the  Beagle  voyage 
which  undermined  or  impaired  Darwin's  health,  and, 
as  we  have  seen,  thinking  not  of  the  "  small  disagree- 
able parts  "  of  the  voyage,  but  that  it  was  the  most 
fortunate  thing  of  his  life.  When  he  landed  in  Eng- 
land his  "  nervous  system "  was  not  only  not  "  ex- 
hausted "  but  was  in  an  exceptionally  sound  and  ac- 
tive condition.  He  had  no  illness  at  all  for  the  next 
8 


io6  BIOGRAPHIC    CLINICS. 

year,  and  as  his  son  says,  failing  health  after  that 
came  on  only  "  gradually."  There  was  no  "  persis- 
tent overstrain  "  of  "  hard  intellectual  life  " ;  there 
was  indeed  but  a  small  part  of  what  thousands  of 
others  carry  on  without  a  symptom.  There  seems  to 
be  a  childish  popular  error,  shared  even  by  those  who 
should  be  accurate,  that  the  solving  of  intellectual  prob- 
lems such  as  those  which  busied  Darwin's  mind  is  more 
wearing  and  disastrous  to  the  health  and  mind  than  the 
mental  exertion  of  the  simplest  intellects  in  the  stren- 
uous life  which  millions  have  to  carry  on.  The  fact 
is  that  almost  all  great  thinkers  have  lived  to  a  ripe 
old  age.  As  to  the  "  rest-treatment "  it  frequently 
happens  that  the  rest-cure  does  not  cure  unless  reading 
and  writing  are  interdicted,  or  proper  glasses  ordered, 
and  that  many  neurasthenics  are  cured  by  glasses  with- 
out the  rest-cure.  In  other  words,  "  neurasthenia " 
may  be  caused  by  eye-strain.  The  ill-defined  symp- 
toms grouped  under  the  indefinite  word  are  those  most 
commonly  enumerated  by  patients  to  the  oculist,  and 
their  relief  by  correction  of  the  optical  errors  is  the 
rule.  Calling  the  symptoms  neurasthenia  does  not  ex- 
plain their  origin,  and  to  cure  them  scientifically  and 
permanently  it  is  necessary  to  prevent  the  causes 
upon  which  they  depend. 


THOMAS    HUXLEY. 


i«7 


CHAPTER  IV. 

THOMAS   HUXLEY. 

The  following  excerpts  and  facts  concerning  the 
life  of  Thomas  H.  Huxley  are  from  the  "  Life  and 
Letters  "  by  his  son. 

He  was  bom  May  4,  1825. 

As  a  boy  he  "  read  everything  he  could  lay  hands  on  in  his 
father's  library."  "  Not  satisfied  with  the  ordinary  length  of 
the  day,  he  used,  when  a  boy  of  12,  to  light  his  candle  before 
dawn,  pin  a  blanket  around  his  shoulders,  and  sit  up  in  bed  to 
read  Hutton's  'Geology.'"     (His  son.) 

"  While  very  young  I  commenced  the  study  of  medicine 
under  a  medical  brother-in-law."     (Huxley  of  himself.) 

"  I  am  now  occasionally  horrified  to  think  how  little  I  ever 
knew  or  cared  about  medicine  as  the  art  of  healing."     (Ibid.) 

"  I  was  a  mere  boy — I  think  between  13  and  14  years  of  age 
— when  I  was  taken  by  some  student-friends  of  mine  to  the 
first  post-mortem  examination  I  ever  attended.  All  my  life 
I  have  been  most  unfortunately  sensitive  to  the  disagreeables 
which  attend  anatomical  pursuits,  but  on  this  occasion  my 
curiosity  overpowered  all  other  feelings,  and  I  spent  two  or 
three  hours  in  gratifying  it.  I  did  not  cut  myself,  and  none  of 
the  ordinary  symptoms  of  dissection-poison  supervened,  but 
poisoned  I  was  somehow,  and  I  remember  sinking  into  a 
strange  state  of  apathy.  ...  I  soon  recovered,  but  for  years  I 
suffered  from  occasional  paroxysms  of  internal  pain,  and  from 
that  time  my  constant  friend,  hypochondriacal  dyspepsia,  com- 
menced his  half-century  of  co-tenancy  of  my  fleshy  taber- 
nacle."    (Ibid.) 

109 


no  BIOGRAPHIC    CLINICS. 

About  the  age  of  21,  in  studying  for  an  examination  he 
"  worked  really  hard  from  8  or  9  in  the  morning  until  12  at 
night."  "  A  great  part  of  the  time  I  worked  till  sunrise.  The 
result  was  a  sort  of  ophthalmia  which  kept  me  from  reading 
at  night  for  months  afterwards."     (Ibid.) 

He  received  the  degree  of  M.B.,  in  1845,  and  entered  the 
Navy  as  Assistant  Surgeon  in  1846.  The  cruise  of  The 
Rattlesnake  ended  November  9,  1850.  He  at  once  plunged  into 
work,  and  in  1852  is  described  as  looking  "  thin  and  ill."  (27 
years  of  age.) 

The  hopelessness  of  obtaining  a  living  by  pure  science  came 
near  making  him  take  up  some  other  occupation.  "  I  will  not 
attempt  my  own  profession,"  chronicles  his  renunciation  of 
medicine.  (27.) 

His  son  says  that  in  1853  to  go  abroad  from  home  or  to  do 
any  work  (reading)  before  breakfast  ensured  him  a  head- 
ache for  the  rest  of  the  day,  so  that  he  was  never  one  of 
those  risers  with  the  dawn  who  do  half  a  day's  work  before 
the  rest  of  the  world  is  astir.  He  had  a  bad  bout  of  ill- 
health  at  the  end  of  the  year,  when  he  "  reformed,"  rising  at 
8,  and  going  to  bed  at  12.     (28.) 

In  a  letter  from  Tenby,  South  Wales,  he  says:  "I  have 
been  here  since  the  middle  of  August  .  .  .  banishing  dyspep- 
sia, hypochondria  and  all  such  other  town  afflictions."     (29.) 

"  With  you  I  envy  .  .  .  his  gastric  energies.  I  feel  I  have 
done  for  myself  in  that  line,  and  am  in  for  a  life-long 
dyspepsia.  I  have  not  now  nervous  energy  enough  for  stomach 
and  brain  both — and  if  I  work  the  latter,  not  even  the  fresh 
breezes  of  this  place  (Tenby)  will  keep  the  former  in  order. 
(29.) 

"  I  wish  I  could  ascertain  the  exact  juste  milieu  of  work 
which  will  suit,  not  my  head  or  will,  these  can't  have  too 
much;  but  my  absurd  stomach."    (31.) 

Open-air  occupation  and  tramping  from  ten  to  sixteen  miles 
a  day  gave  him  immediate  relief.  "  You  can't  think  how  well 
I  am  so  long  as  I  walk  eight  or  ten  miles  a  day,  and  don't 
work  too  much."     (31.) 


THOMAS  HUXLEY.  in 

Longer  walking  tours,  in  England,  and  in  Switzerland 
during  the  summer  holidays  now  become  the  necessity  and 
the  rule  to  recruit  from  "overwork."     (31.) 

In  1857-1858  his  health  was  greatly  tried.  Headache !  head- 
ache! is  his  repeated  note.  There  are  many  entries  such  as 
the  following:  "Used  up,"  "hypochondriacal  and  bedevilled," 
"not  good  for  much,"  "toothache,  incapable  all  day,"  "voice- 
less," "missed  lecture,"  "unable  to  go  out."     (32-33.) 

In  1862  he  was  compelled  to  go  to  bed  for  ten  days  by  an 
unaccountable  prostration  of  strength  which  he  thinks  was  due 
to  "obstruction  of  the  liver."     (37.) 

"  I  had  a  pain  about  my  eyes  a  few  months  ago,  but  I  found 
spectacles  made  this  rather  worse,  and  left  them  off  again. 
However,  I  do  catch  myself  holding  a  newspaper  further  off 
than  I  used  to  do."    (39.) 

At  the  age  of  47  his  son  says  that  "  dyspepsia,  the  most 
distressing  of  maladies,  had  laid  firm  hold  upon  him."  Even 
rests  and  holidays  did  no  good  at  this  time.  He  confessed 
that  "  in  the  long  struggle  against  ill-health  he  had  been 
beaten."  "Beyond  general  weariness,  incapacity  and  disgust 
with  things  in  general,  I  do  not  know  precisely  what  is  the 
matter  with  me."     (47.) 

"  My  incessant  dyspeptic  nausea."     (47.) 

He  was  now  (1872)  forced  to  take  a  long  vacation,  and 
from  Egypt  he  writes  that  a  month  of  utter  and  absolute 
laziness  had  completely  set  him  up  and  he  was  "  well  as  ever." 
(47.) 

He  returned  home  sunburnt  and  bearded  almost  beyond 
recognition;  but  "as  soon  as  he  began  to  work  again  in 
London,  his  old  enemy  dyspepsia  returned."  Special  diet  and 
another  trip  abroad  were  ordered  by  Dr.  Andrew  Clark,  and 
this  effected  a  "  cure."     (47.) 

But  in  two  weeks  after  this  "cure"  he  was  "just  keeping  the 
devil  of  dyspepsia  at  arm's  length."  In  two  months  more  he 
was  forced  to  give  up  again  for  two  months  and  go  away  for 
a  rest. 


112  BIOGRAPHIC    CLINICS. 

"  It  isn't  my  brains  that  get  wrong  but  only  my  confounded 
stomach."  "  As  my  doctor  told  me,  I  was  sound  mind  and 
limb,  and  had  merely  worn  myself  out."     (47.) 

"  I  have  been  worried  to  death  with  dyspepsia,  and  the 
hypochondriacal  bedevilments  that  follow  its  train." 

The  fact  is  repeated  in  another  letter.     (47.) 

In  January,  1873,  he  was  "getting  better  from  a  fresh 
breakdown  of  dyspepsia,"  but  he  was  forced  to  exist  on  the 
"strictest  ascetic  principles." 

He  had  been  seriously  ill  with  severe  mental  depression.  He 
now  took  a  long  summer  vacation,  walking,  geologizing,  etc., 
and  "  gradually  discarding  doctor's  orders."  In  a  few  days  he 
was  better,  and  in  two  months,  "wonderfully"  so,  "another 
man,"  etc.  He  now  thinks  "the  enemy  is  beaten,"  tracing  it 
all  to  cutting  down  food,  etc.       (48.) 

In  1875  his  health  was  maintained  on  a  satisfactory  level, 
"thanks  to  the  regimen,"  etc.     (50.) 

But  in  1876,  he  is  "in  rather  a  hypochondriacal  state  of 
mind";  "I  will  see  if  this  course  of  medicine  will  drive  the 
seven  devils  out."     (51.) 

There  is  less  complaint  from  this  time  to  1884,  when  "the 
burden  of  ill-health  grew  slowly  and  steadily.  Dyspepsia  and 
the  hypochondriacal  depression  again  attacked  him  as  they 
had  attacked  him  twelve  years  ago."  "  His  energy  was 
sapped."  Nothing  could  bring  him  to  work.  We  note  that 
in  the  worst  condition  ("spoon-meat"  and  "inanity")  a  ten- 
mile  walk  was  possible  and  helpful.     (59.) 

He  eats,  drinks,  and  sleeps  "like  a  top."     (59.) 

"We  are  fearfully  and  wonderfully  made,  especially  in  the 
stomach — which  is  altogether  past  finding  out."     (59.) 

"I  find  myself  distinctly  aged,  tired  out,  body  and  soul, 
afraid  of  work.  Physically  I  have  nothing  much  to  complain 
of  except  weariness."  "There  is  not  the  slightest  sign  of 
organic  disease  anywhere."     (59.) 

"  I  am  convinced  that  the  prophet  Jeremiah  must  have  been 
a  flatulent  dyspeptic— there  is  so  much  agreement  between  his 
views  and  mine."     (59.) 


THOMAS  HUXLEY.  113 

Sir  Andrew  Clark  now  finds  "  nothing  wrong  except  a  slight 
affection  of  the  liver  and  general  nervous  depression.  He 
orders  him  to  go  South  and  do  nothing  but  amuse  himself  for 
three  or  four  months."  (59.) 

He  again  complains  of  "  weariness  and  deadness  hanging 
over  him,  accompanied  by  a  curious  nervous  irritability."    (59.) 

He  goes  to  Italy,  but  writes  from  Rome  in  January,  1885, 
that  he  is  no  "  forarder."  He  is  well  for  a  few  days  and 
then  all  adrift,  and  "have  to  put  myself  right  by  dosing  with 
Clark's  pills,  which  are  really  invaluable."  The  pills  were 
strychnin,  but  by  February  "  Clark's  strychnia  did  not  answer 
so  well,"  and  he  began  taking  quinin.  By  March  there  was 
some  improvement.  In  April  he  returned  home,  and  Clark 
could  only  tell  him  he  had  a  "bad  color."     (60.) 

Lassitude  and  depression  seized  him  and  Clark  ordered 
him  to  quit  all  work.  He  resigns  his  government  positions. 
By  May  he  was  "  in  a  disgusting  state  of  blue  devils,"  although 
there  was  really  nothing  the  matter,  and  a  month  later  he 
was  worse — "blue  devils  and  funk,  funk  and  blue  devils. 
Liver  I  expect."     (60.) 

In  1886  he  had  been  "going  steadily  down,"  and  he  called 
in  a  physician  who  told  him  that  "  more  physicking  was  no 
good,"  and  told  him  to  be  off  to  the  moors  to  see  what  exer- 
cise and  fresh  air,  etc.,  could  do.  Ten  to  sixteen  miles  a  day 
at  once  brings  him  up  again,  banishes  the  blue  devils,  etc.  "  I 
wish  I  know  what  is  the  matter  with  me."     (61.) 

"I  do  a  minimum  of  ten  miles  per  diem  without  fatigue 
and  as  I  eat,  drink  and  sleep  well  there  ought  to  be  nothing 
the  matter  with  me.  Why  under  these  circumstances  I 
should  never  feel  honestly  cheerful  or  know  any  other  desire 
than  that  of  running  away  and  hiding  myself,  I  don't  know. 
No  explanation  is  to  be  found  even  in  Foster's  *  Physiology ' ! 
The  only  thing  my  demon  can't  stand  is  sharp  walking,  and  I 
will  give  him  a  dose  of  that  remedy  when  once  I  get  into 
trim."  A  single  day  at  Ilkley  improves  him  so  that  he  says  he 
feels  like  an  impostor  for  running  away  and  "  I  can  hardly 


114  BIOGRAPHIC    CLINICS. 

believe  that  I  felt  so  ill  and  miserable  twenty-four  hours  ago." 
(61.) 

In  1886,  in  June,  from  the  country  he  writes  that  he  has  for 
five  months  found  that  a  few  days  in  London  knocks  him  up, 
and  he  must  go  back  to  the  moors.     (61.) 

He  goes  abroad  again,  getting  better  at  once,  as  usual,  but 
in  London  he  came  down  again,  and  went  to  Yorkshire  in 
December  to  be  "mended."     (61.) 

The  first  half  of  1887  "was  chequered  by  constant  returns 
of  ill-health."  In  June  he  is  sent  to  bed,  "  a  touch  of  pleurisy 
with  muscular  rheumatism,"  and  he  is  ordered  off  to  Switzer- 
land, and  at  once  was  well  again.  There  was  more  pleurisy 
in  1888.     (62.) 

"As  long  as  I  have  nothing  to  do  I  have  nothing  to  com- 
plain of"— but  he  gets  worse  steadily.  He  was  on  his  back 
and  taking  iron  and  digitalis  in  June,  as  it  turned  out  "his 
heart  was  out  of  order."  He  was  very  ill  when  he  again 
arrived  at  Maloja,  not  being  able  to  walk  100  yards,  but  in 
two  months  he  could  again  walk  ten  miles  and  climb  2,000 
feet  without  difficulty. 

His  heart  gets  bad  when  he  is  kept  indoors,  however.  On 
his  return  to  England  he  is  again  bad,  but  goes  to  Eastbourne 
and  the  downs  and  the  daily  walk  again  made  the  bad  symp- 
toms disappear.  In  December  his  physician  (Hames)  tells 
him  there  are  left  only  slight  indications  of  heart  trouble.  (63.) 

There  was  returning  vigor  in  1889;  he  was  out  of  doors  all 
the  time;  Sir  Henry  Thompson  scoffed  at  the  idea  of  his  ever 
having  had  a  dilated  heart.     (64.) 

There  was  little  complaint  now.  "Broken  health  was 
restored"  and  with  out-of-door  life,  until  1895  when  influ- 
enza and  bronchitis  supervened  some  "renal  trouble,"  and 
death  followed  on  June  29,  at  the  age  of  70. 

As  a  medical  case  we  have,  therefore,  a  man  who 
from  childhood  applied  himself  to  study  with  tre- 
mendous energy  and  persistence.     Beyond  all  doubt 


THOMAS  HUXLEY.  115 

he  never  had  any  organic  disease;  the  supposed  dila- 
tion of  the  heart  was  even  laughed  at  by  Sir  Henry 
Thompson  a  few  years  before  his  death.  And  yet 
from  the  age  of  fourteen  he  was  a  great  sufferer.  A 
man  of  Huxley's  nature  does  not  complain  except  upon 
the  most  adequate  and  real  warrant.  His  suffering 
for  fifty  years  wrung  from  him  the  most  bitter  com- 
plaints, and  forced  him  for  the  latter  part  of  his  Hfe 
to  renounce  what  he  held  dear  in  the  world,  and  to 
renounce  it  more  and  more  absolutely  with  every  added 
year  of  life.  The  result  of  all  his  study  of  his  own 
case,  the  result  of  all  his  consultation  of  physicians, 
was  that  neither  he  nor  the  physicians  had  the  least 
idea  what  ailed  him.  He  was  constantly  puzzled  by 
the  inexplicable  mystery.  As  Carlyle  had  said  of  him- 
self, he  ''  might  as  well  have  poured  his  sorrows  into 
the  long  hairy  ear  of  the  first  jackass  he  came  upon, 
as  of  this  select  medical  man."  The  result  of  all  treat- 
ment except  of  one  kind  was  nil.  Even  up  to  his  last 
years  walking  in  the  open  air  and  renunciation  of 
study,  reading,  and  writing,  never  failed  to  give  him 
immediate  relief,  again  made  him  "  as  well  as  he  ever 
was  in  his  life,"  so  that  after  such  walks  he  ate,  drank, 
and  slept,  "  like  a  top."  It  shows  how  truly  Huxley 
diagnosed  his  own  unfitness  for  the  work  of  a  prac- 
tical physician,  when  we  reflect  that  his  wretchedness 
of  fifty  years  never  made  him  catch  any  hint  of  the 
fact  that  whenever  he  began  study,  reading,  or  writing 


ii6  BIOGRAPHIC    CLINICS. 

he  suffered,  and  whenever  he  stopped  these  things  he 
was  at  once  well.  During  his  whole  life  he  was  teach- 
ing and  urging  upon  others  the  study  of  physiology. 
But  he  never  suspected  the  significance  of  the  physiol- 
ogy of  the  eye  and  of  astigmatism,  and  of  their  rela- 
tion to  his  bad  health.  What  was  his  disease?  It 
was  functional,  surely,  and  it  was  so  terribly  real  that 
one  can  hardly  imagine  what  tragedy  it  brought  to 
him;  great  as  were  the  study,  work,  and  scientific  re- 
sults of  his  life,  it  prevented  him  from  making  far 
more  of  that  life  than  we  can  know.  The  mellowing 
effect  of  years,  experience,  and  love  of  his  fellow  men 
were  indeed  but  just  beginning  to  show  the  splendid 
possibilities  of  the  future,  when,  "  Resign,  renounce, 
stop  work ! "  became  the  absolute  commands  of  the 
doctors,  and  of  fate. 

At  the  age  of  fourteen  he  had  been  reading  for  a 
number  of  years  with  all  that  fiery  energy  and  reck- 
lessness so  characteristic  of  him.  At  this  time  he  was 
present  at  the  dissection  table  "  for  two  or  three 
hours."  One  smiles  as  one  reads  the  naive  words,  "  I 
did  not  cut  myself,  and  none  of  the  ordinary  symp- 
toms of  dissection  poison  supervened,  but  poisoned  I 
was,  somehow,  etc."  He  had  indeed  a  strange  sort  of 
toxemia,  but  its  origin  was  surely  not  the  post-mortem 
table.  ''  Apathy  "  and  his  fifty  years  of  "  hypochon- 
driacal dyspepsia  "  now  began. 

At  about  the  age  of  twenty-one,  excessive  ocular 


THOMAS  HUXLEY.  1 17 

labor  brought  on  "  a  sort  of  ophthalmia  "  which  pre- 
vented him  from  reading  at  night  for  months.  During 
the  four  years  of  the  cruise  of  the  Rattlesnake  there 
was  no  complaint  of  ill-health,  as  in  Darwin's  case  also 
there  was  no  eye-strain  or  not  enough  to  cause  it.  On 
his  return  to  work  on  shore  at  the  age  of  twenty-six 
he  was  soon  thin  and  ill,  and  at  the  age  of  twenty- 
seven  he  could  not  read  before  breakfast  without  re- 
sultant headaches  for  the  rest  of  the  day,  so  that,  after 
an  illness,  he  "  reformed  "  his  habits  and  went  to  bed 
at  midnight,  and  arose  at  8.  Nothing  now  checks  the 
reign  of  the  mysterious  dyspepsia,  liver  affection — 
stomach-trouble,  nausea,  flatulent  dyspepsia,  headache, 
hypochondria — nothing,  except  quitting  study.  At 
the  age  of  about  forty-nine  he  got  some  respite  and 
for  about  ten  years  there  was  far  less  complaint.  But 
from  the  age  of  59  to  64  his  old  troubles  and  some 
new  ones  brought  him  much  grief.  With  the  estab- 
lishment of  complete  presbyopia  at  63  or  64  there  was 
no  further  complaint. 

It  is  certain  that  our  patient  had  far-sighted  astig- 
matism at  least  of  one  or  two  diopters  (compound 
hyperopic  astigmatism),  probably  with  a  difference  in 
the  refractive  error  of  the  two  eyes  (anisometropia)  ; 
perhaps  he  had  also  some  lack  of  balance  of  the  ex- 
ternal ocular  muscles  (heterophoria)  and  almost  cer- 
tainly he  had  good  or  normal  acuteness  of  vision  of 
the  two  eyes.     He  probably  never  consulted  an  oph- 


ii8  BIOGRAPHIC    CLINICS. 

thalmologist.  How,  then,  may  all  of  this  be  more  than 
guessed  ?  By  his  own  "  Method  of  Zadig."  It  is  a 
pity  that  this  method  had  not  been  applied  to  himself; 
that  his  physiology  was  not  practical,  or  morbid,  or 
clinical. 

He  had  far-sighted  astigmatism  because  every  per- 
son has  it  upon  whose  attention  it  has  been  forced, 
that  at  the  age  of  38  or  39  he  had  been  compelled  to 
hold  the  paper  farther  away  than  heretofore.  Pres- 
byopia is  not  manifest  in  the  emmetropic  eye  for  half 
a  dozen  years  later  in  life.  He  had  astigmatism  and 
probably  anisometropia  because  of  the  fact  that  the 
crude  spectacles  he  got  from  some  optician,  were,  of 
course,  simple  plus  spherical  lenses,  and  both  alike, 
and  as  they  increased  his  trouble  rather  than  lessened 
it  he  surely  was  astigmatic,  and  almost  certainly  anis- 
ometropic.  He  probably  had  heterophoria  ("  insuffi- 
ciency "  or  latent  strabismus)  because  long-continued 
eye-strain  from  the  causes  mentioned  usually  produces 
this  imbalance  of  the  external  ocular  muscles.  He 
had  retained,  or  normal,  visual  acuteness  because,  as  is 
the  almost  exceptionless  rule,  that,  when  a  vicious  eye- 
strain reflex  spends  its  strength  on  other  organs,  cere- 
bral or  digestional,  the  eye  itself  is  spared.  If  Huxley 
had  had  persistent  ocular  symptoms  such  as  conjunc- 
tivitis, amblyopia,  etc.,  he  would  not  have  had  the 
systemic  symptoms,  gastric,  digestional,  etc.,  which 
he  endured  for  fifty  years.    The  superlative  impor- 


THOMAS  HUXLEY.  119 

tance  of  the  function  of  vision  to  the  organism,  animal 
or  human,  has  made  Nature,  with  perfect  wisdom, 
turn  the  harmful  eye-strain  reflex  upon  other  organs 
than  the  eye.  Huxley's  eye-strain  symptoms  corre- 
spond in  a  general  way  to  those  of  others  but  with 
the  inevitable  differences  and  peculiarities  of  all  bio- 
logic phenomena.  We  must  remember  that  his  extra- 
ordinary energy  of  mind  and  body  gave  him  note- 
worthy powers  of  resistance  and  recuperation.  This 
demonstrates  all  the  more  convincingly  the  single  na- 
ture and  cause  of  his  sufferings.  The  immediate 
cessation  of  the  effects  of  eye-strain  when  he  walked 
from  ten  to  sixteen  miles  a  day,  or  climbed  mountains, 
or  tramped  the  moors,  shows  at  once  the  natural  rug- 
gedness  and  health  of  all  his  organs,  and  the  single 
cause  of  his  ill-health.  Lectures,  teaching,  experi- 
mental work,  etc.,  would  have  doubtless  given  him 
relief  from  eye-strain,  if  he  could  have  had  a  stenog- 
rapher, or  some  one  to  read  aloud  to  him,  and  if  he 
had  not  himself  read  useless  things. 

The  mounting  of  the  childhood  curve  of  symptoms 
to  a  crisis  came  at  about  the  age  of  14,  when  there 
was  the  strange  experience  he  so  naively  describes  as 
if  resulting  from  his  attendance  at  the  dissection  table. 
From  it  Huxley  dates  the  beginning  of  "  the  half- 
century  of  co-tenancy  of  dyspepsia  of  his  fleshy  taber- 
nacle." The  emotional  revulsion  against  dissection  ^ 
was  plainly  a  part  but  a  very  small  part  of  the  cause 


I20  BIOGRAPHIC   CLINICS. 

of  the  "  co-tenancy."  At  21  Huxley's  use  and  abuse 
of  his  eyes  caused  an  attack  of  conjunctivitis  which 
lasted  for  several  months.  The  resistance  of  the  cere- 
bral and  digestional  organs  to  the  morbid  reflexes,  a 
resistance  greatest  at  this  time  of  life,  threw  these 
reflexes  back  upon  the  eyes  themselves.  During  the 
next  seven  years  all  organs  withstood  the  strain  the 
best,  but  at  28  reading  before  breakfast  caused  head- 
ache for  the  rest  of  the  day,  and  he  had  such  a  bad 
bout  of  ill-health  that  he  changed  the  habits  of  his  life, 
quitting  study  at  12  o'clock  at  night,  and  rising  at  8 
A.  M.  He  had  now  to  take  a  vacation  to  banish  "  dys- 
pepsia, hypochondria,  and  other  town  afflictions,"  and 
he  began  to  learn  that  if  he  worked  his  brain  much  he 
had  stomach  trouble  and  not  even  the  fresh  breezes  of 
Tenby  would  enable  him  to  recuperate.  It  is,  of 
course,  absurd  to  think  that  in  Huxley  brain-work 
alone  could  have  such  a  result.  He  knew  better  well 
enough.  His  "  head  or  will  could  never,"  as  he  later 
said,  "  have  too  much  work."  But  eye-labor  always 
and  quickly  brought  an  end  of  the  "  nervous  energy  " 
necessary  for  digestion.  And  so  as  in  the  lives  of 
all  those  we  have  studied  began  the  "  tramp,  tramp, 
tramp,"  in  the  open  air,  which  alone  gave  relief.  And 
even  with  this  the  "headache,  headache,"  dyspepsia, 
and  dyspeptic  nausea,  hypochondria,  and  apathy,  con- 
tinued and  grew  worse,  and  prove  tragic  until  about 
the  age  of  48  or  50,  when  there  was  some  relief  last- 


THOMAS   HUXLEY.  121 

ing  eight  or  ten  years.  This  period  of  partial  relief 
is  illogical  on  the  theory  of  unrelieved  eye-strain,  as  it 
usually  does  not  come  until  at  about  the  age  of  60,  at 
the  completion  of  accommodation  failure.  It  would 
surely  be  readily  explainable  if  we  had  all  the  facts  at 
hand,  and  had  not  to  deal  with  hints,  unintended  sug- 
gestions, overhearings,  etc.,  as  to  the  actual  clinical 
history.  I  suspect  that  at  the  age  of  48  or  49  when 
there  was  some  change  for  the  better  in  his  general 
symptoms,  there  was  a  considerable  lessening  of  eye- 
strain from  some  spectacles  which  he  would  now  be 
compelled  to  catch  up  somewhere,  in  order  to  decipher 
print.  Ten  years  previously  he  had  felt  the  need  of 
lenses,  had  tried  such  as  he  could  get,  but  with  these 
the  ocular  pain  was  worse  and  he  struggled  on  for  the 
next  years  of  his  severest  trials.  That  his  relief  from 
49  to  59  came  from  the  relief  of  eye-strain  is  to  me 
indubitable,  and  although  it  was  not  then  possible  that 
his  error  of  refraction  could  be  at  all  accurately  cor- 
rected, there  are  many  things  that  could  have  cooper- 
ated to  lessen  the  results  of  abnormal  ocular  function. 
His  presbyopia,  which  had  become  manifest  at  least 
six  years  earlier  than  usual,  shows  that  his  ametropia 
was  of  a  high  degree,  and  the  guess-work  spectacles 
could  have  had  any  one  of  a  number  of  effects.  While 
the  spectacles,  in  the  long  run,  were  harmful,  or  at 
least  not  accurately  corrective,  still  they  helped  to  give 
some  kind  of  more  or  less  morbid  relief.  Moreover, 
9 


122  BIOGRAPHIC    CLINICS. 

accommodation  in  his  case  was  failing  fast  at  50 ;  lastly 
it  would  have  been  strange  if  in  thirty-six  years  Hux- 
ley should  not  have  learned,  even  if  blindly  and  em- 
pirically, how  far  he  could  go  in  the  use  of  the  eyes 
without  too  much  injury.  However  much  or  little  he 
may  have  temporarily  bettered,  there  was  a  distinct 
recrudescence  of  all  symptoms  at  the  age  of  59,  and 
he  was  driven  to  resign  his  public  offices  and  again  to 
attack  the  moors,  where,  even  now,  walking  ten  or 
sixteen  miles  a  day  again  brought  health  and  happi- 
ness. His  demon,  as  of  old,  could  not  stand  sharp  walk- 
ing. This  fact  strongly  suggests  that  he  had  always 
and  still  had  an  unsymmetric  or  anisometropic  astig- 
matism which  could  not  then  have  been  even  approxi- 
mately corrected  and  of  which  the  direct  irritating 
results  would  continue  until  presbyopia  was  complete; 
the  secondary  consequences  might  last  for  the  re- 
mainder of  life. 

"  Let  me,''  says  Huxley,  "  confine  myself  to  the  one 
matter  on  which  my  experience  as  a  student  of  medi- 
cine, and  an  examiner  of  long  standing,  who  has  taken 
a  great  interest  in  the  subject  of  medical  education, 
may  entitle  me  to  a  hearing.  What  is  the  object  of 
medical  education  ?  It  is  to  enable  the  practitioner,  on 
the  one  hand,  to  prevent  disease  by  his  knowledge  of 
hygiene,  and  on  the  other  hand,  to  divine  its  nature, 
and  to  alleviate  or  cure  it,  by  his  knowledge  of  pathol- 
ogy, therapeutics,  and  practical  medicine.     That  is  his 


THOMAS  HUXLEY.  i^3 

business  in  life,  and  if  he  has  not  a  thorough  and  prac- 
tical knowledge  of  the  conditions  of  health,  of  the 
causes  which  tend  to  the  establishment  of  disease,  of 
the  meaning  of  symptoms  and  of  the  uses  of  medicines 
and  operative  appliances,  he  is  incompetent,  even  if  he 
were  the  best  anatomist,  or  physiologist,  or  chemist, 
that  ever  took  a  gold  medal  or  won  a  prize  certificate. 
To  understand  the  nature  of  disease  we  must  under- 
stand health,  and  the  understanding  of  the  healthy 
body  means  the  having  a  knowledge  of  its  structure 
and  of  the  way  in  which  its  manifold  actions  are  per- 
formed. Physiology  is,  to  a  great  extent,  applied  phys- 
ics and  chemistry.  What  we  call  therapeutics  has  to 
do  with  the  action  of  drugs  and  medicines  on  the 
living  organism.^  And  there  is  no  position  so  ignoble 
as  that  of  the  *  liberally-educated  practitioner,'  who 
finds  himself  with  the  issues  of  life  and  death  in  his 
hands,  ignorant,  blundering,  and  bewildered,  because 
of  his  ignorance  of  the  essential  and  fundamental 
truths  upon  which  practice  must  be  based."  ("  Uni- 
versity Education,"  Huxley.) 

These  words,  from  the  Johns  Hopkins  address, 
were  spoken  in  the  fullness  of  his  powers,  by  the 
physiologist,  par  excellence,  and  the  "  student  of  medi- 
cine," who  thought  himself  and  was  indeed  in  one 
way,  especially  well  fitted  to  speak  with  authority  upon 
the  subject;  but  he  had  been,  as  we  know,  a  profound 

^A  small  part  of  therapeutics  nowadays. 


124  BIOGRAPHIC    CLINICS. 

sufferer  all  his  life  from  some  disease  which  baffled 
his  best  medical  advisers,  and  of  which  he  said,  "  I 
wish  I  knew  what  is  the  matter  with  me."  One  of 
the  most  fundamental  and  important  of  the  senses,  one 
of  the  greatest  of  physiologic  functions,  the  origin  and 
creator  of  intellect,  is  vision.  Of  its  physiology  Hux- 
ley was  incurious.  Its  malfunction  in  his  case 
wrecked  his  life  and  when  he  read,  made  every  day 
a  day  of  wretchedness.  Whenever  he  read  or  wrote 
he  suffered,  whenever  he  stopped  reading  or  writing 
he  was  well.  Notwithstanding  this  Huxley  wrote 
"  The  Method  of  Zadig." 


ROBERT    BROWNING. 


"S 


CHAPTER  V. 

ROBERT    BROWNING. 

When,  in  1845,  Robert  Browning  fell  in  love  with 
Elizabeth  Barrett,  he  was  32  years  of  age.  The  first 
quotation  given  below  from  one  of  the  early  letters 
shows  that  while  certainly  not  connected,  his  headache 
began  about  the  same  time.  Up  to  this  time  he  had 
been  free  from  such  symptoms.  Let  me  gather  a  few 
of  the  many  allusions  in  two  years'  correspondence  to 
the  symptoms  of  ill-health  of  which  he  complained  or 
to  which  Miss  Barrett  referred: 

"  I  have  had  a  constant  pain  in  the  head  for  these  two 
months,  which  only  very  rough  exercise  gets  rid  of.  I  thought 
I  could  never  be  unwell."     (May  3,  1845.) 

"  I  am  quite  well  now  or  next  to  it — but  this  is  how  it  was. 
I  have  gone  out  a  great  deal  of  late,  and  my  head  took  to 
ringing  such  a  literal  alarum  that  I  wondered  what  was  to 
come  of  it :  and  at  last,  a  few  evenings  ago,  as  I  was  dressing 
for  a  dinner  somewhere,  I  got  really  bad  of  a  sudden  and  kept 
at  home.    Next  morning  I  was  no  better."     (May  12,  1845.) 

How  is  your  head?  (E.  B.  to  R.  B.,  May  27,  1845.) 

"  You  will  have  advice,  will  you  not,  if  that  pain  does  not 
grow  much  better  directly?  It  cannot  be  prudent  or  safe  to  let 
a  pain  in  the  head  go  on  so  long  and  no  remedy  for  it  be 
attempted?  You  cannot  be  sure  that  it  is  merely  a  nervous 
pain  and  that  it  may  not  have  consequences,  and  this  quite 

127 


128  BIOGRAPHIC    CLINICS. 

apart  from  the  consideration  of  suffering?"   (E.  B.,  June  7, 

1845.) 

"  I  am  confident  that  that  pain  should  not  be  suffered  to 
go  on  without  something  being  done.  What  I  said  about 
nerves  related  to  what  you  had  told  me  of  your  mother's 
suffering  and  what  you  had  fancied  of  the  relation  of  it  to 
your  own.  Not  that  I  believe  in  the  relation  .  .  .  because  such 
things  are  not  hereditary,  are  they?  and  the  bare  coincidence 
is  improbable.  You  see  it  is  just  as  I  thought — for  that 
whether  too  much  thought  or  study  did  or  did  not  bring  on 
the  illness —  .  .  .  yet  you  admit  that  reading  and  writing 
increases  it — as  they  naturally  would  any  sort  of  pain  in  the 
head.  ...  If  it  does  you  good  to  go  out  and  take  exercise, 
why  not  go  out  and  take  it?  If  you  will  agree  to  be  well,  first, 
I  will  promise  to  be  ready  afterwards  to  help  you  in  anything 
I  can  do — transcribing  or  anything  to  get  the  books  through 
the  press  in  the  shortest  of  times.  I  am  capable  of  a  great 
deal  of  that  sort  of  work  without  being  tired,  having  the  habit 
of  writing  in  any  sort  of  position,  ...  on  the  arm  of  a 
chair,  or  the  seat  of  one,  sitting  myself  on  the  floor  and  calling 
myself  a  Lollard  for  dignity.  ...  Do  give  up  the  writing  and 
all  that  does  harm."     (E.  B.,  June  24,  1845.) 

"  I  fear  I  shall  not  be  able  to  bring  you  the  rest  [of  the 
MSS.]  to-morrow  because  I  have  been  broken  in  upon  more 
than  one  morning;  nor,  though  much  better  in  my  head,  can 
I  do  anything  at  night  just  now."     (July  9,  1845.) 

"Are  you  any  better  to-day?  .  .  .  Will  you  attempt  to  do 
none  of  the  writing  which  does  you  harm — nor  of  the  reading 
even,  which  also  may  do  harm?"  (E.  B.,  July  25,  1845.) 

"Let  me  try  and  answer  your  note  to-morrow.  I  will  not 
hide  from  you  that  my  head  aches  now."     (July  28,  1845.) 

"  To-day  I  cannot  write — though  I  am  very  well  otherwise." 
(July  31,  1845.) 

"And  your  head,  how  is  it?"  (This  query  of  Miss  Barrett 
occurs  in  fully  one  third  of  her  letters.) 

"  So  much  reading  hurts  me ;  .  .  .  whether  the  reading  be 
light    or    heavy,    fiction    or    fact,    and    so    much    writing — 


ROBERT    BROWNING.  129 

whether  my  own — such  as  you  have  seen,  or  the  merest  com- 
pliments— returning  to  the  weary  tribe  that  exact  it  of  one." 
(August  8,  1845.) 

"  How  can  it  be  that  you  are  unwell  again,  and  that  you 
should  talk  of  being  weary  in  your  soul !  You  ?  What  should 
make  you  weary  in  soul?  Or  out  of  spirits  in  any  way?  Or 
is  it  that,  being  unwell,  your  spirits  are  affected  by  that?"  (E. 
B.,  August  25,  1845.) 

"  Do  take  more  exercise  this  week  and  make  war  against 
those  dreadful  sensations  in  the  head."     (E.  B.,  August  31, 

1845.) 

"And  my  all  important  headaches  are  tolerably  kept  under 
— headaches  proper,  they  are  not — ^but  the  noise  and  slight 
turning  are  less  troublesome."     (September  5,  1845.) 

"How  is  the  head?  I  fancied  the  other  day  you  were  look- 
ing better  rather  than  otherwise;  but  those  sensations  in  the 
head  are  frightful  and  ought  to  be  stopped  by  whatsoever 
means."     (E.  B.,  November  21,  1845.) 

"  And  now  that  the  headache  has  begun  again,  and  the 
worse  than  headache — "  (E.  B.,  November  25,  1845.) 

"  When  your  brother  and  I  took  the  book  between  us,  we 
turned  to  the  index  between  us  and  stopped  at  *  Miss  B.,'  and 
he,  indeed,  read  them  or  some  of  them,  but  holding  the 
volumes  at  such  a  distance  as  defied  my  short-sighted  eye,  that 
all   I   saw   was   the   faint   small   characters."      (December   9, 

1845.) 

"  I  will  not  try  to  write  much  to-night,  for  my  head  gives 
warning."     (January  26,  1845.) 

"  To  my  sorrow,  I  must  give  up  the  delight  of  seeing  you 
this  morning.  I  went  out  unwell  yesterday  and  a  long  noisy 
dinner^  with  speechmaking  and  long  walk  at  the  end  of  it — 
these  have  given  me  such  a  bewildering  headache  that  I 
really  see  some  reason  in  what  they  say  here  about  keeping  the 
house."     (February  7,  1846.) 

^  Called  to-day  theater-headache,  panorama-headache,  crowd- 
headache,  etc.,  and  often  occurring  in  astigmatic  patients. 


I30  BIOGRAPHIC    CLINICS. 

"I  am  rather  hazy  in  the  head."    (March  i8,  1846.) 

"For  all  the  walking  my  head  aches."    (March  24,  1846.) 

"Do  you  notice  how  stupid  I  am  to-day?  My  head  begins 
[to  ache]  again;  that  is  the  fact;  it  is  better  a  good  deal  than 
in  the  morning.  With  the  deep  joy  in  my  heart  below,  what 
does  the  head  mean  by  its  perversity."     (March  29,  1846.) 

"  Say  how  are  you  to-morrow— don't  forget.  The  cause  of 
the  unwellness  I  see,  if  you  do  not.  It  was  the  proof  correct- 
ing—I expected  that  you  would  be  unwell."  (E.  B.,  March  31, 
1846.) 

"  I  confess  to  have  written  myself  all,  but— tired— headachy." 
(April  7,  1846.) 

On  April  21,  R.  B.  writes :  "  My  love  must  sit  to-day  in  the 
gondola  chair  and  let  me  talk  to-day — not  write — to  her,  for 
my  head  aches — part  from  pure  perversity  and  a  little  from 
my  morning  spent  over  a  novel  of  Balzac's — that  is  it,  not 
any  real  illness  I  know — however  the  effect  is  the  same."  To 
which  E.  B.  responds,  April  22,  1846 :  "  How  could  you  get 
that  headache?  First  with  not  walking;  then  with  walking!  ! 
and  reading  Balzac!"  To  this  R.  B.  answers,  April  23,  1846: 
"I  was  never  very  ill  and  am  now  much  better.  I  mean  to 
cooperate  with  your  wishes  and  my  doctor's  doings  and  so, 
how  should  I  fail  of  bringing  into  subjection  this  restive  ill- 
conditioned  head  of  mine?" 

"  I  scarcely  know  what  to  say  about  the  poem.  It  is  almost 
profane  and  a  sin  to  keep  you  from  writing  when  your  mind 
goes  that  way — yet  I  am  afraid  that  you  cannot  begin  without 
doing  too  much  and  without  suffering  as  a  consequence  in 
your  head."     (E.  B.,  May  26,  1846.) 

"I  will  write  more  to-morrow — the  stupid  head  will  not  be 
quiet  to-day — (my  mother's  head  is  sadly  affected  too)  partly 
because  I  have  been  reading."     (June  2,  1846.) 

"I  think  my  head  is  dizzy  with  reading  the  debates  this 
morning."     (June  30,  1846.) 

"  Since  you  will  be  teased  with  intelligence  about  it,  my 
head  was  not  very  well  yesterday,  but  it  is  decidedly  better 
this  morning."     (July  20,  1846.) 


ROBERT    BROWNING.  131 

"  I  was  not  quite  so  well  this  morning  early,  but  the  little 
head  there  was  to  go,  has  gone,  and  I  am  about  to  go  out.  My 
mother  continues  indisposed.  The  connection  between  our 
ailings  is  no  fanciful  one.  A  few  weeks  ago,  when  my  medical 
adviser  was  speaking  about  the  pain  and  its  cause  (my  mother 
sitting  by  me)  he  exclaimed,  *  Why,  has  anybody  to  search 
far  for  a  cause  of  whatever  nervous  disorder  you  may  suffer 
from,  when  there  sits  your  mother  whom  you  so  absolutely 
resemble!  I  can  trace  every  feature,'  etc."  (August  22,  1846.) 
"I  write  with  an  aching  head."  (August  31,  1846.) 
"  My  head  will  not  get  quite  well."  (September  2,  1846.) 
"When  I  had  finished  that  letter  this  morning,  before  I 
could  seal  it  even,  I  became  quite  ill  and  so  sick  as  to  be 
forced  to  go  upstairs  and  throw  myself  on  the  bed."  The  next 
day  (September  4)  he  writes:  "I  am  very  much  better — my 
head  clear  from  pain  if  a  little  uncertain."  Again  on  Septem- 
ber 5  he  writes :  "  My  head  still  teases  rather  than  pains  me." 
Two  days  later  he  writes :  "  I  am  not  to  see  you  to-morrow. 
I  got  up  with  the  old  vertiginousness  or  a  little  worse,  and  so 
went  to  consult  the  doctor — I  am  bidden  to  go  to  bed  for  a 
day  or  two.  So  here  I  am  writing,  leaning  on  my  elbow  in 
bed,  as  I  never  wrote  before,  I  think.  Mind,  I  may  read  or 
write — only  in  bed  I  must  lie,  because  there  is  some  tempera- 
ture to  be  kept  up  in  the  skin — or  some  other  cause  as  good — 
"  for  reasons,  for  reasons."  The  next  day  he  writes :  "  Here 
I  lie  with  a  dizzy  head — unable  to  read  more  than  a  page  or 
two — there  is  something  in  the  unwonted  position  that  tires 
me — but  whenever  the  book  is  left  off,  I  turn  to  the  dark  side 
of  the  room — and  so  I  am  soon  better  and  able  to  try  again." 
The  following  day  "  the  lightness,  slight  uneasiness  of  the 
head  continues,  though  the  general  health  is  much  better,  it 
seems." 

"  Each  summer  brought  him  to  the  state  of  nervous  pros- 
tration or  physical  apathy."     (Mrs.  Orr  in  "  Life  of  E.  B.  B.") 
"  Liver,"    "  deranged   liver,"    etc.,    is    the    complaint    made, 
"though  no  doctor  pronounced  the  evil  serious."    (Mrs.  Orr.) 


132  BIOGRAPHIC    CLINICS. 

He  caught  a  "bronchial  cold"  in  Venice,  just  before  his 
death,  and  the  symptoms  were  aggravated  by  "the  asthmatic 
tendency,"  and  "exhaustion  of  the  heart."  He  laid  it,  as 
usual,  to  the  liver. 

He  died  December  12,  1889,  at  the  age  of  'jd. 

"He  was  very  proud  of  his  retentive  memory,  and  of  his 
well  preserved  sight.  The  latter  he  attributes  to  his  practice 
of  bathing  his  eyes  in  cold  water  every  morning.  He  was 
proud  too  of  his  strength,  of  his  power  of  walking  for  hours 
without  fatigue,  of  the  few  requirements  of  his  Spartan-like 
daily  life."  (Katharine  De  Kay  Bronson,  The  Century  Maga- 
zine, February,  1902,) 

Browning  was  a  man  of  refined  and  sensitive  na- 
ture, self-controlled,  careful  of  himself  and  of  his 
health,  a  perfectly  well-regulated  man,  living  temper- 
ately in  all  things,  well-to-do,  and  with  no  need,  by 
inheritance,  or  conditions,  ever  to  go  to  any  extreme 
in  life.  He  had  been  remarkably  well,  he  informs  us, 
up  to  the  age  of  32.  If  we  had  accurate  data  prior  to 
this  time  we  should  doubtless  find  that  the  moderation 
and  quietness  of  his  nature  and  demeanor  were  in 
great  part  the  lessons  unconsciously  derived  from  the 
forgotten  experiences  as  regards  health  in  youth.  A 
boy  with  the  astigmatism  he  had  could  never  have  been 
a  hard  student  or  immoderate  in  any  way  without  ill- 
health  resulting.  After  the  time  we  know  him  (32) 
we  find  him  always  extremely  sensitive  to  slight  ex- 
cesses of  irritation,  such  as  a  late  dinner,  excitement, 
etc.  It  never  needed  but  a  small  thing  to  upset  his 
delicate  health.     Even  reading  a  few  minutes  would 


ROBERT    BROWNING.  I33 

bring  on  the  head  trouble,  and  a  few  minutes  of 
ocular  rest  would  make  it  disappear.  Each  winter's 
work  (with  the  eyes)  brought  him  to  the  state  of 
nervous  prostration  and  physical  apathy,  and,  as  of 
old,  it  was  charged  automatically  to  "  liver,  deranged 
liver,"  although  the  evil  was  "  not  serious,"  and  he 
had  no  organic  disease  whatever.  For  the  twenty 
months  of  the  time  of  the  letters,  the  only  time  we  get 
any  very  definite  insight  of  his  life,  he  was  plagued 
and  tormented  by  what  he  called  headache,  but  which 
Miss  Barrett  said  was  worse  than  headache.  Ver- 
tigo, or,  as  he  wrote,  "  the  old  vertiginousness,"  "  diz- 
ziness," ''  not  headaches  proper  but  the  noise  and  slight 
turning,"  "  ringing  in  the  head,"  "  lightness,"  "  hazi- 
ness," etc.,  are  other  terms  used  to  describe  it.  Like 
Huxley  he  found  that  he  must  take  long  walks  every 
day  in  order  to  be  free  from  suffering,  and  like  him 
he  also  found  he  must  give  up  use  of  the  eyes  at  night. 
There  are  also  crises  of  "  nervous  prostration," 
"  weariness  of  soul,"  "  physical  apathy,"  all  relieved 
at  once  by  walking.  There  is  one  noticeable  differ- 
ence between  Browning  and  Huxley  in  the  time  of  the 
onset  of  the  ocular  reflexes.  In  Huxley's  powerful 
and  tough  system  they  did  not  begin  immediately,  but 
seemed  to  culminate  in  the  crises  at  longer  intervals 
and  more  severely.  In  Browning's  case  they  came  at 
once  with  a  very  little  reading  or  writing.  Sometimes 
a  few  minutes'  reading  would  produce  them,  and  a 


^3*4  BIOGRAPHIC   CllNicS. 

few  minutes  of  rest  give  relief.  This  is  according  t6 
the  rule;  when  the  insult  of  the  reflex  expends  itself 
upon  the  cerebrum  the  symptoms  show  the  closer  and 
quicker  nexus ;  when  upon  the  digestional  system  they 
are  slower  in  appearing.  The  more  sensitive  the  na- 
ture, the  more  the  reflex  tends  to  be  cerebral,  the  more 
resistant,  the  more  it  tends  to  be  digestional.  Carlyle 
and  Huxley  would,  therefore,  not  have  headache  so 
much  as  dyspeptic  or  "  liver  "  symptoms.  Browning 
had  chiefly,  though  not  solely,  the  cerebral  type  of 
reflex.  The  worst  kind  of  organization  is  that  in 
which  there  is  a  balance,  or  such  a  combination  of 
the  two  that  the  reflexes  aflfect  both  sets  of  organs. 
The  result  in  these  cases  is  "  biliousness,"  "  biUous 
headache,"  or  "  sick-headache,"  one  of  the  most  awful 
affections  and  most  frequent  which  afflicts  humanity. 
The  case  of  Darwin  is  an  illustration.  In  Browning's 
case,  although  according  to  the  fashion,  he  occasion- 
ally blamed  the  "  Hver,"  and  sometimes  had  nausea, 
the  headache  and  the  dizziness,  with  other  odd  symp- 
toms of  cerebral  disorder  were  the  chief  complaints. 
He  was  a  man  without  organic  disease,  living  a  tem- 
perate life  of  ease,  and  yet  in  the  prime  of  life,  with 
every  attempt  at  reading,  writing,  or  correcting  proof, 
he  found  himself  with  headaches  and  vertigo;  imme- 
diate relief  came  by  stopping  near  use  of  the  eyes,  by 
walking,  etc.  Nothing  can  be  more  certain  in  diag- 
nosis than  that  a  man  with  such  symptoms  is  suffer- 


ROBERT    BROWNING.  13S 

ing  from  reflex  ocular  neurosis.  Miss  Barrett  saw 
the  close  connection  between  proof-reading  or  writing 
and  headache,  although  Browning  seems  not  to  have 
noticed  it,  even  in  writing  the  words  which  he  said 
caused  it. 

But  is  there  no  better  proof?  Zadig  shall  again 
help  us.  Browning  says  that  with  a  book  between 
himself  and  Mr.  Barrett,  "  he  [Barrett]  indeed  read, 
but  holding  the  volume  at  such  a  distance  as  defied  my 
short-sighted  eye,  so  that  all  that  I  saw  was  the  faint 
small  characters."  These  last  words  cannot  of  course 
be  taken  literally,  i.  e.,  it  was  not  the  faint  small  char- 
acters alone  of  the  page  that  he  saw,  the  large  clear 
letters  not  being  seen.  His  symptom-description  was 
as  incorrect  and  obscure  as  some  say  his  poetry  fre- 
quently is.  He  meant  that  at  the  distance  Barrett  held 
the  book  all  the  letters  appeared  small  and  faint. 
There  is  no  form  of  ametropia  which  increase  of 
distance  would  make  faint  small  characters  appear 
more  visible  than  large  clear  ones.  Moreover,  it  could 
not  have  been  simple  "  short-sightedness "  which 
Browning  said  he  had,  that  produced  the  impression 
of  faintness  and  smallness  in  the  letters  when  held  far 
away.  Patients  have  yet  to  learn  the  facts  about  the 
optical  terms  commonly  used.  A  "  far-sighted  "  man 
may  not  be  really  far-sighted,  and  a  so-called  "  near- 
sighted "  man  may  not  in  fact  be  near-sighted.  That 
is  to  say,  a  man  with  a  high  degree  of  far-sightedness, 


136  BIOGRAPHIC    CLINICS. 

or  hyperopia,  may  be  unable  to  see  far-off  things  clear- 
ly, and  a  "near-sighted"  man  may  not  be  myopic,  as 
several  defects,  especially  amblyopia,  may  compel  him 
to  hold  the  book  very  close  to  his  eyes.  The  presence 
of  complicating  astigmatism  and  amblyopia  may  make 
the  word  "  near-sighted  "  have  no  literal  or  scientific 
significance.  Simple  myopia  (near-sightedness)  could 
not  have  the  effect  Browning  described,  nor  could 
simple  hyperopia  (or  far-sightedness).  Moreover, 
these  simple  isometropic  defects  of  either  kind  would 
not  produce  the  reflex  headaches  and  vertigo  plainly 
due  to  his  eyes.  It  is  only  astigmatism  that  could 
have  produced  both  the  pain  and  the  "  faint  small  char- 
acters," and  an  astigmatism  which  could  no  longer  be 
neutralized  by  the  muscle  of  accommodation.  That 
by  care  and  ease  of  life  Browning  reached  the  age  of 
32  without  severe  symptoms  of  eye-strain  and  ill- 
health  shows  that  at  that  time  a  greater  amount  of 
writing  and  reading  was  undertaken,  or  that  the  astig- 
matism could  no  longer  be  overcome  by  the  ciliary 
muscle  or  the  function  of  "  accommodation."  Pos- 
sibly both  causes  were  operative,  the  latter  dominating. 
That  the  astigmatism  was  hyperopic  and  not  myopic 
is  also  certain  or  extremely  probable,  and  it  must  have 
been  of  a  high  degree  or  he  would  not  have  thought 
himself  "near-sighted."  This  "near-sightedness" 
was  doubtless  also  heightened  by  amblyopia,  for  a  high 
degree  of  hyperopic  astigmatism  existing  uncorrected 


ROBERT    BROWNING.  i37 

for  thirty-two  years  almost  certainly  produces  ambly- 
opia. All  patients  think  such  amblyopia  is  "  near- 
sightedness," because  to  see  print  plainly  they  have  to 
force  the  page  closer  than  the  fourteen-inch  normal, 
and  conversely  when  the  page  is  held  say  at  two  feet 
or  more  away  the  letters  become  "  faint  and  small." 

I  have  noted  that,  once,  walking  did  not  cure  Brown- 
ing's headache,  and  Miss  Barrett  glanced  at  the  fact 
with  her  keen  diagnostician's  eye.  The  contradictions 
she  caught  him  in  as  regards  the  cause  and  cure  of 
his  headache  at  this  particular  time,  should  not  be  tak- 
en too  seriously.  While  Cupid  blinds  men  he  makes 
women  almost  supernaturally  clairvoyant.  Brown- 
ing's own  reportings  of  his  case  are  less  clear  and 
truthful  in  what  he  really  says  than  in  what  he  implies 
or  unintentionally  says. 

The  glimpses  we  get  of  the  medical  attendant  are 
not  encouraging.  In  one  respect  his  therapeutics  re- 
sembles that  of  some  modern  rest-curers  who  send 
patients  to  bed  and  allow  them  to  read  there,  as 
Browning  did,  when  the  cause  of  their  "  neurasthe- 
nia," etc.,  is  due  to  eye-strain.  Then  there  is  wonder 
that  the  rest-cure  did  no  good.  Others  stop  the  read- 
ing and  writing  while  the  patient  is  in  bed,  and  there 
is  a  speedy  return  of  health — followed,  with  near  use 
of  the  eyes,  by  a  '*  breakdown  "  as  prompt.  Browning 
is  sent  to  bed  in  order  that  "  some  temperature  shall 
be  kept  up  in  the  skin  (sic!),  or  for  some  cause  as 

10 


138  BIOGRAPHIC    CLINICS. 

good,  at  least,  '  for  reasons,  for  reasons.' "  And  he 
may  read  and  write,  so  he  stays  in  bed,  although  it 
causes  headache  at  once  to  do  so,  and  whenever  the 
book  is  left  off  and  he  turns  to  the  dark  side  of  the 
room  he  is  relieved  and  is  able  to  read  another  page. 

Both  Browning  and  the  medical  adviser  find  a  per- 
fect explanation  of  Browning's  headache  in  heredity. 
"  Why  has  anybody  to  search  for  a  cause  ?  There  sits 
your  mother  whom  you  so  absolutely  resemble !  I  can 
trace  every  feature,  etc."  If  this  explains  it,  Adam, 
or  rather.  Eve,  must  have  been  afflicted  in  the  same 
way,  and  all  of  her  descendants  to  Browning's  mother. 
One  marvels  how  a  headache  can  be  inherited,  and 
why  family  facial  resemblances  demonstrate  the  fact. 
Throwing  the  responsibility  back  upon  the  mother,  or 
upon  Eve,  will  no  longer  do,  and  I  think  we  should 
give  it  up.  Browning  and  his  medical  adviser  may 
not  be  censured  for  such  a  naive  medical  philosophy, 
but  really  we  grown-ups  must  quit  such  hide-and-go- 
seek  childish  games.  We  must  find  what  caused  the 
headache  in  each  case,  separately,  of  son  and  mother, 
at  least  if  we  wish  to  cure  the  son.  An  antihereditive 
medicine  has  not  so  far  been  discovered  effective  after 
the  patient's  birth. 

For  forty-two  or  forty-three  years  after  this  Brown- 
ing lived,  but  I  find  few  data  of  value  or  trustworthi- 
ness for  further  knowledge  of  his  clinical  biography. 
Like    De    Quincey,    Carlyle,    Darwin,    and    Huxley, 


ROBERT    BROWNING.  I39 

Browning  never  suspected  the  cause  of  his  suffering, 

and  learned  only  that  it  was  in  some  mysterious  way 

eluded  by  long  walks  and  persistent  exercise.     Mrs. 

Bronson  says  he  never  passed  a  day  without  taking  one 

or  more  long  walks;  indeed,  his  panacea  for  most  ills 

was  exercise,  and  the  exercise  he  chiefly  advocated  was 

walking.     He  wrote: 

"  I  get  as  nearly  angry  as  it  is  in  me  to  become  with  people 
I  love  when  they  trifle  with  their  health, — that  is,  with  their 
life, — like  children  playing  with  jewels  over  a  bridge-side, 
jewels  which,  once  in  the  water,  how  can  we,  the  poor 
lookers-on,  hope  to  recover?  You  don't  know  how  absolutely 
well  I  am  after  my  walking." 


BILIOUSNESS   AND    HEADACHE. 


141 


CHAPTER  VI. 

BILIOUSNESS   AND   HEADACHE. 

According  to  the  composite  medicine  and  psychol- 
ogy of  the  ancient  and  medieval  philosophers  there 
were  four  cardinal  liquids,  or  humors,  of  the  body, 
which,  according  to  the  predominance  of  one,  and  the 
mixture  of  all,  were  supposed  to  form  the  tempera- 
ment, temper  (temporo,  to  mix),  or  disposition  of  a 
man.  These  humors  were  called  the  blood,  the 
phlegm,  the  choler,  and  the  black  choler.  We  to-day 
say  of  one  that  he  is  sanguine,  phlegmatic,  choleric,  or 
melancholic,  and  the  meanings  are  not  much  different 
from  those  given  them  for  the  past  2,000  years.  If  a 
horse  has  a  certain  affection  he  is  said  to  have  the 
distemper,  that  is,  the  four  humors  are  badly  mixed, 
and  our  terms,  good-tempered,  good-humored,  in  a 
temper,  bad-humored,  etc.,  show  how  thoroughly  this 
old  humoral  physiology  was  believed  and  worked  into 
our  language  and  our  habits  of  thought.  Even  our 
word,  humor,  meaning  wit,  is  derived  from  the  same 
source.  The  blood  has  retained  its  old  significance. 
Phlegm  we  understand  now  as  the  viscid  mucus  of 
the  inflamed  upper  air-passages  (^Xiyetv,  to  burn), 
and  the  choler,  or  yellow  bile,  we  also  know.     But 

143 


144  BIOGRAPHIC    CLINICS. 

what  could  have  led  to  the  belief  in  a  black  bile  or 
choler?  As  near  as  we  can  say,  it  was  a  blunder  due 
to  the  lack  of  a  scientific  spirit  in  anatomy  and  phys- 
iology. The  liver  secreted  choler  or  yellow  bile,  and 
the  renal  and  suprarenal  glands  were  believed  to  secrete 
black  bile  or  atrahilis,  whence  our  obsolescent  word, 
atrabiliary,  used  as  late  as  1849  by  Lowell,  1866  by 
Carlyle,  and  even  in  1877  by  Froude.  Two  things 
were  thus  supposably  explained  by  the  theory  of  the 
humors :  The  first  that  mental  qualities,  character,  and 
disposition,  were  thus  formed.  Science,  or  scientific 
physiology,  thus  began  with  an  unconscious  material- 
ism and  fatalism — the  material  construction  and  func- 
tions of  the  body  inevitably  produced  and  dominated 
character.  Perhaps  this  old  snake  of  superstition  (or, 
preferably,  "substitution")  is  not  yet  wholly  dead; 
Weissmann,  Lombroso,  and  the  scientific  monists  are 
still  able  to  stimulate  some  wriggling  of  its  tail,  but 
a  wise  psychology  smiles  cynically  at  the  crude  gal- 
vanistic  experiments. 

The  second  conclusion  of  the  humoral  theory  was 
the  humoral  pathology,  that  all  diseases  are  due  to 
disorder  and  abnormalism  of  the  humors.  We  were 
early  able  to  exclude  the  black  bile  from  the  patho- 
genic role  because  there  is  no  black  bile.  Perhaps  the 
gloomy  hypochondriac  should  have  some  black  bile  to 
explain  his  despair  in  such  a  world  as  ours,  but  it  must 
evidently  be  accounted  for  in  some  other  way.     That 


BILIOUSNESS    AND   HEADACHE.  i45 

one  who  is  physically  sanguine  should  be  emotionally 
so  we  no  longer  believe,  and  that  pharyngitis  or  bron- 
chitis has  any  power  to  produce  psychic  phlegmatism 
is  hardly  consistent  with  sound  laryngology. 

But  how  is  it  with  the  yellow  choler?  Is  there  any 
doubt  that  Carlyle  (and  thousands  of  sufferers  from 
similar  diseases)  thoroughly  believed  his  daily  wretch- 
edness for  forty  years  was  due  to  "  bile  "  ?  Sir  An- 
drew Clark  told  the  patient  Huxley  he  had  a  better 
color,  i.  e.,  less  choler,  than  when  he  sent  him  to  Italy. 
Biliousness  was  a  very  real  complaint  to  the  physicians 
of  the  past  century,  and  try  as  they  may  the  writers 
of  modem  medical  books  can  not  abolish  the  word 
"  bilious."  As  to  the  lay  world  that  word  is  used 
almost  every  day  in  almost  every  household  in  the 
land,  and  to  the  users  it  signifies  some  mysterious  con- 
nection with  hepatic  function  and  product.  Quackery 
may  be  said  to  feed  upon  biliousness  (which  may  ex- 
plain its  extraordinary  gall!),  and  the  quack  or  the 
physician  who  could  cure  it  by  any  medicine  would  be 
the  most  successful  physician  in  the  world.  For  it  is 
evident  that  in  some  mysterious  way  this  most  mys- 
terious of  diseases  is  responsible  for  a  big  round  share 
of  the  world's  suffering. 

But  what  is  it  to  be  bilious?  I  have  asked  many 
men  and  more  books,  and  no  two  answers  are  alike, 
no  two  reconcilable.  Originally,  of  course,  it  must 
have  meant  the  secretion  of  too  much  bile,  as  pre- 


146  BIOGRAPHIC    CLINICS. 

dominance  of  any  one  of  the  humors  made  the  indi- 
vidual physically  and  mentally  the  exponent  of  the 
qualities  of  that  humor.  But,  although  this  error  will 
still  persist  for  long,  there  are  a  hundred  opinions  and 
conditions  and  facts  which  make  it  impossible  to  hold 
it  with  any  degree  of  absoluteness  or  consistency.  Of 
Ben  Thompson,  the  noted  desperado  of  Texas,  one  of 
his  sympathizers  said,  "  Ben  is  a  little  bilious,  but  he 
will  come  all  right  again  as  soon  as  he  has  killed  a 
man."  There  are  many  such  supposed  connections 
between  biliary,  psychic,  and  sociologic  functions. 

To  the  lay  mind  the  logical  and  physiological  connec- 
tion between  ill-temper  or  choler,  and  derangement  of 
the  liver,  was  so  unquestionable  that  the  conclusion 
was  inevitably  drawn  that  if  a  man  were  fault-finding 
and  bad-humored  he  must  certainly  be  pathologically 
bilious.  Probably  that  logic  has  incited  more  purge- 
taking  and  dyspepsia-treating  than  the  profession 
would  now  care  to  acknowledge.  Traces  of  it  may 
be  plainly  seen  in  the  text-books  of  to-day,  but  the  fact 
is  undoubted  in  those  of  fifty  or  one  hundred  years 
ago. 

But  those  were  good  and  wise  books  nevertheless — 
quite  as  helpful,  much  more  so,  even,  as  those  issued 
from  the  press  last  year,  so  far  as  pertains  to  this 
subject.  Let  me  make  a  few  selections  from  two  of 
these  old  books  by  Drs.  Watson  and  Tweedie,  and 
written  about  sixty  years  ago: 


BILIOUSNESS    AND    HEADACHE.  i47 

"  There  are  states  of  mind  and  habits  of  life,  which,  having 
no  direct  relation  to  the  organs  of  digestion,  yet  exercise  a 
material  influence  over  their  functions.  Mental  distress ; 
mental  solicitude;  mental  toil;  over-much  study;  want  of 
exercise :  these  are  all  prolific  sources  of  dyspepsia.  .  .  .  Pre- 
scribe change:  change  of  air;  change  of  place  and  of  scenery; 
change  of  society.  Get  him  to  travel  in  search  of  health;  and 
the  chances  are  in  favor  of  his  finding  it.  Six  weeks  among 
the  mountains  of  Switzerland,  etc.  .  .  .  with  these  disjointed 
hints,  gentlemen,  I  must  request  you  to  be  satisfied  in  respect 
to  the  principles  upon  which  dyspepsia — and  the  hypochon- 
driasis which  is  generally  so  closely  linked  with  dyspepsia — 
are  to  be  managed.  A  full  discussion  of  these  subjects  in 
detail  would  furnish  matter  for  several  lectures." 

"  Indigestion  is  often  accompanied  by  pain  in  the  head,  with 
some  confusion  of  thought :  or  at  all  events  with  a  loss  of 
mental  energy  and  alertness.  Together  with  a  violent  head- 
ache there  are  frequently  nausea  and  vomiting;  and  the  com- 
plaint is  popularly  known  by  the  name  of  the  sick-headache: 
or,  in  the  fashionable  jargon  of  the  day,  as  a  bilious 
headache." 

"...  Scarcely  a  winter  passed  over  in  which  several  of  his 
pupils  did  not  apply  to  him  on  account  of  palpitations  sup- 
posed by  them  to  depend  upon  structural  disease  of  the  heart : 
and  in  no  single  instance  were  these  apprehensions  well 
founded.  They  were  all  cases  of  mere  dyspepsia  and  hypo- 
chondriasis." Cullen  defines  hypochondriasis  to  be  dyspepsia 
— cum  languore,  maestitia,  et  metu,  ex  causis  non  sequis. 

"  The  symptoms  of  acute  dyspepsia  are  anorexia,  weight  and 
fullness  at  the  epigastrium,  nausea,  eructations,  .  .  .  dull 
headache  along  the  supraorbital  ridge,  confusion  or  incapacity 
of  thought,  and  despondency.  .  .  .  The  evacuation  of  the 
stomach  is  generally  followed  by  a  feeling  of  great  relief,  and 
the  sympathetic  disorders  soon  subside.  .  .  .  Another  form  of 
acute  functional  disorder,  to  which  the  stomach  is  liable  is 
what  passes  under  the  popular  term  bilious  seizure.     Many 


148  BIOGRAPHIC    CLINICS. 

of  the  symptoms  in  this  affection  are  the  same  as  in  the 
former,  but  the  spontaneous  sickness  is  more  violent,  etc.  .  .  . 
The  attack  is  generally  preceded  by  indisposition,  languor, 
dulness,  chilliness,  loss  of  appetite,  and  giddiness.  Some  can 
foretell  its  approach  by  derangement  of  sight,  consisting  of 
general  indistinctness,  or  a  sensation  of  darkness,  etc.  .  .  . 
Such  persons  are  constitutionally  liable  to  such  disorders,  and 
are  said  to  possess  the  bilious  temperament." 

"  In  chronic  dyspepsia  the  symptoms  are  almost  coextensive 
with  the  whole  economy,  .  .  .  discomfort,  indisposition,  lassi- 
tude and  an  aching  weariness,  which  patients  often  designate 
emphatically  as  wretchedness.  .  .  .  Dejection,  anxiety,  irrita- 
bility of  temper,  and  incapability  of  taking  pleasure  or  interest 
in  anything  whether  in  the  physical  or  moral  world.  .  .  . 
Muscae  volitantes,  .  .  .  headache  particularly  over  the  eyes." 

"  Gastralgia  is  an  affection  that  corresponds  to  the  gas- 
trodynia  and  cardialgia  of  some  authors,  the  morbid  sensi- 
bility of  the  stomach  described  by  Dr.  James  Johnson,  and 
the  irritable  gastric  dyspepsia  of  Dr.  Todd.  .  .  .  Temper  irri- 
table, .  .  .  costive,  .  .  .  headache  of  a  tense  character,  .  .  . 
prey  to  morbid  gloom." 

"  As  to  the  restriction  of  diet,  patients  say  that  their  friends 
partake  of  all  such  things;  but  the  best  answer  to  such 
remarks  is,  that,  as  *  to  the  pure  all  things  are  pure,*  so,  in  our 
sense,  to  the  whole  all  things  are  wholesome." 

"  Without  insisting  on  the  general  physiological  doctrine  of 
the  despondency  of  glandular  action  upon  the  nervous  sys- 
tem, we  may  remark  that  various  pathological  phenomena 
lead  to  the  recognition  of  an  organic  influence  exerted  by  the 
brain  over  the  biliary  function  in  particular;  but  we  shall  find 
that  it  is  not  always  very  clear  whether  it  is  the  secretion  or 
excretion  of  the  bile  that  is  primarily  affected  in  this  manner. 
.  .  .  The  recognition  of  a  class  of  maladies,  termed  bilious, 
without  the  precise  significance  of  this  term  having  been 
clearly  defined.  Some  physicians  understand  excess  of  bile, 
others  deficiency,  or  when  it  is  vitiated,  others  extend  the  term 


BILIOUSNESS    AND    HEADACHE.  i49 

to  all  derangements  of  the  digestive  functions,  attended  with 
any  form  of  biliary  disorder." 

"  We  have  little,  in  the  way  of  palliation,  in  our  power.  .  .  . 
It  must  be  admitted  that  the  knowledge  we  at  present  possess 
of  the  biliary  secretion  in  health  and  disease  does  not  enable 
us  to  lay  down  any  rational  indications  for  the  correction  of 
its  morbid  conditions." 

If  we  turn  from  the  pathology  and  practice  of  sixty 
years  ago  to  that  of  to-day  do  we  find  anything  more 
helpful?  I  do  not  think  so.  As  to  these  matters  our 
most  modem  books  seem  to  me  to  be  infinitely  less 
helpful.  When  the  young  medical  graduate  goes  out 
to  treat  patients  these  most  common  complaints  and 
tormenting  complainants  will  turn  up  the  first  day  and 
every  day.  He  has  not  as  a  rule  been  taught  in  book, 
lecture,  or  clinic,  anything  half  as  good  as  was  taught 
the  student  of  the  olden  time.  In  the  first  place  his 
most  newest  Practice  of  Medicine  Bible  will  probably 
ignore  the  real  Practice  of  Medicine  pretty  thoroughly. 
It  is  made  for  the  author's  benefit,  not  for  that  of  the 
student.  It  is  theoretical  not  practical,  "  diagnostical 
not  therapeutical."  And  just  in  proportion  to  the 
author's  fame  will  it  be  so.  In  the  second  place  it  has 
usually  succeeded  in  ignoring  functional  diseases  alto- 
gether, whereas  the  functional  diseases  produce  far 
more  suffering  than  the  organic  diseases.  I  believe 
that  these  troubles  labeled  bilious  and  headache  alone 
cause  more  wretchedness  than  all  the  organic  diseases 
in  the  world.     And  yet  little  or  no  simple  common  help 


15©  BIOGRAPHIC    CLINICS. 

will  the  puzzled  young  doctor  get  from  most  of  the 
modern  books.  They  are  all  very  scientifical,  it  is 
true,  and  it  is  all  very  **  magnificent,  but  it  is  not  war  " 
— at  least  against  disease.  The  modern  patient  as  a 
last  resort  can  also  be  waved  to  Switzerland,  if  he  is 
rich  enough  to  go,  or  to  the  dispensary  if  he  is  one  of 
the  999  in  i,ooo.  Book  after  book  will  utterly  ignore 
these  subjects,  or  only  speak  of  the  symptoms  in  a 
score  of  different  places  as  those  of  a  score  of  different 
organic  diseases,  always  however  as  a  bit  of  necessary 
routine,  mechanically,  because  others  have  done  so,  etc. 
Out  of  many  I  have  found  two  that  cursorily  allude 
to  eye-strain  as  etiologic  factors,  but  plainly  without 
any  thought  or  care  for  the  subject,  and  stupidly  un- 
derstanding by  the  term  the  over-use  of  normal  eyes, 
instead  of  the  use  of  optically  abnormal  eyes.  From 
a  very  up-to-date  book  I  quote  the  following: 

"...  At  the  same  time,  owing  to  the  absorption  of  poisons 
into  the  system,  certain  constitutional  symptoms  are  noticed 
such  as  a  sense  of  fatigue,  oppression,  vertigo,  headache,  and  a 
disturbance  of  sight.  The  complexion  may  be  more  or  less 
muddy,  having  lost  its  clear  character.  Such  a  collection  of 
symptoms  is  usually  placed  under  the  head  of  'biliousness,' 
and  not  without  reason,  as  the  liver  is  no  doubt  inadequate 
to  the  proper  arrest  of  the  ptomains,  found  in  such  large 
quantity." 

"An  objection  to  these  views  may  arise  from  the  fact  that 
many  individuals  suffer  for  years  from  chronic  constipation 
and  maintain  a   fair  standard  of  health." 

"  It  is  however  a  well-known  fact  that  individuals  suffering 
from    chronic    constipation    frequently    exhibit    symptoms    of 


BILIOUSNESS    AND    HEADACHE.  151 

biliousness,  such  as  headache  and  vertigo,  as  well  as  many 
mental  peculiarities,  hypochondriasis,  tendency  to  melancholia, 
etc.  These  are  no  doubt  the  result  of  .  .  .  action  of  ptomains 
upon  the  nerve  centers.  ...  If  the  power  of  the  liver  as  a 
sentinel  is  lessened,  the  toxins  ordinarily  found  in  the  diges- 
tive tract  may  circulate  through  the  system  producing  many 
of  the  symptoms  of  biliousness." 

We  are  also  told  by  this  author  that  disturbances  of 
innervation  cause  acute  and  chronic  congestion  of  the 
liver  and  that  in  biliousness  more  or  less  hepatic  in- 
sufficiency exists,  whether  primary  or  secondary.  The 
primary  may  be  of  a  hereditary  character,  slight  sec- 
ondary causes  provoking  nervous  exhaustion  may  pro- 
duce it,  and  neurasthenic  cases  are  frequently  explained 
by  derangement  of  the  liver,  and  that  mental  emotion 
influences  the  liver  secretion.  Other  symptoms  are: 
bitter  taste,  dyspepsia,  cardiac  irregularity,  character- 
istic alvine  evacuations,  nervous  phenomena,  especially 
headache  as  a  dull  pain  in  the  forehead,  vertigo,  dim- 
ness of  vision,  double  vision,  and  sleeplessness.  The 
treatment  consists  in  increasing  the  secretion  of  bile, 
etc. 

One  naturally  expects  to  find  that  the  last  days  of 
humoralism  would  be  humorous !  Perhaps  in  his  des- 
peration a  multivolumed  cyclopedia  is  bought  by  the 
young  practitioner  only  to  find  that  in  the  parcelling 
out  of  subjects  great  gaps  exist  which  should  be  filled 
with  the  discussion  of  the  subjects  of  greatest  interest. 
Headache,   for  instance,  is  either  not  in  the  list  of 


152  BIOGRAPHIC    CLINICS. 

subjects  written  upon,  or  is  only  spoken  of  in  the  dead 
lists  of  symptoms  of  a  hundred  diseases.  In  one  such 
"  system,"  however,  I  have  found  many  pages  of  mat- 
ter upon  this  topic  in  which  the  forms  are  duly  enu- 
merated and  each  at  length  described ;  it  would  take  a 
page  or  two  merely  to  list  the  chief  heads  of  para- 
graphs, the  nervous  headache,  sick,  periodical,  heredi- 
tary, constitutional,  dietary,  hemicranic,  menstrual,  in- 
digestional,  or  bilious  headache;  that  from  mental  or 
bodily  overwork,  of  childhood,  of  tubercular  menin- 
gitis, of  school  children  and  students,  from  affairs  of 
family  and  business,  of  bad  ventilation,  of  malaria,  of 
rheumatism,  of  uterine  diseases,  from  constipation,  of 
hysteria,  of  diseases  of  the  brain  and  spinal  cord  (tu- 
mors, abscess,  etc.),  of  fevers,  of  anemia,  of  delayed 
menstruation,  of  syphilis,  and  so  on,  and  so  on.  "  Fi- 
nally," not  to  forget  the  "  quibusdam  aliis,"  of  the 
"  omni  re  scibili,"  finally  there  are  headaches  that  find 
no  place  in  the  preceding  enumeration  and  that  defy 
all  attempts  to  find  their  cause  or  explanation  " — and 
"  many  cases  of  headache  cannot  be  relieved  by  remov- 
ing the  cause.  .  .  .  Many  patients  should  spend  as 
much  of  their  time  out-of-doors  as  possible." 

"In  explaining  the  recurrence  of  periodical  headaches,  the 
theory  seems  rational  that  supposes  a  nerve  explosion  or 
storm  to  occur  at  stated  intervals,  regardless  of  exciting 
causes,  as  the  centers  reach  a  climax  of  accumulation  or 
exhaustion  of  energy  or  of  some  force  or  principle.  Such  an 
unavoidable  occurrence  is   exactly  what  happens;   a   seizure 


BILIOUSNESS    AND   HEADACHE.  i53 

will  come  when  the  time  is  ripe  for  it  whatever  is  done  to 
prevent  it.  .  .  .  The  explanation  of  reflex  headaches  is  noth- 
ing more  nor  less  than  the  explanation  of  reflex  pains  of  other 
parts  of  the  body,  and  may  be  omitted  here." 

"  The  sympathetic  or  reflex  influences  cause  a  large  number 
of  headaches.  These  influences  are  almost  innumerable. 
Among  them  are" — (not  eye-strain,  astigmatism,  etc.). 

In  place  of  the  thousands  of  years  of  medical  super- 
stition and  pseudoscience,  in  place  of  the  meaningless, 
self-contradictory  and  mutually  contradictory  disquisi- 
tions upon  these  subjects,  in  place  of  the  endless  end- 
ings in  the  clouds  of  practical  helplessness  and  thera- 
peutic nihilism,  even  of  quackery,  it  would  seem  ad- 
visable for  future  lecturers  and  text-book  makers  to 
insert  a  few  sentences  somewhat  like  the  following: 

Even  up  to  the  last  years  the  diseases  called  bilious- 
ness, headache,  dyspepsia,  acute  lithemia,  and  by  many 
other  terms,  were  entirely  misunderstood  and  treat- 
ment was  in  the  highest  degree  unsatisfactory.  But 
there  was  brought  into  practical  use  during  the  last 
quarter  of  the  nineteenth  century  a  discovery  of  as 
great  medical  importance  as  any  made  during  the  cen- 
tury, and  so  far  as  the  relief  of  actual  suffering  is  con- 
cerned, of  far  greater  significance  than  any.  Astig- 
matism, its  influence  upon  the  general  health  and  char- 
acter, and  the  methods  of  correcting  it,  is  the  discovery 
of  which  we  speak,  and  with  the  discovery  the  last 
great  stronghold  of  the  ancient  and  medieval  supersti- 
tion of  the  humoral  pathology  was  taken.  Whenever 
II 


154  BIOGRAPHIC    CLINICS. 

the  symptoms  of  functional  cerebral,  mental,  and  diges- 
tional  disease,  such  as  headache,  dyspepsia,  "  bilious- 
ness," sick-headache,  migraine,  neurasthenia,  anemia, 
vertigo,  insomnia,  anorexia,  constipation,  eructation  of 
gas,  languor,  ill-temper,  melancholia,  etc.,  are  tempor- 
ary or  acute  and  dependent  upon  well-knozvn  excess 
or  abnormalism  in  eating  and  drinking,  the  patient  is 
more  than  stupid  if  he  does  not  tell  you  of  the  fact. 
When  these  symptoms  are  dependent  upon  organic  dis- 
ease you  are  equally  inexcusable  if  you  do  not  soon 
discover  it.  The  vast  majority  of  such  cases,  say,  at 
least  go  percent,  are  not  caused  by  dietary  indiscre- 
tion or  organic  disease,  and  of  these  over  po  percent 
are  reflex  ocular  neuroses;  i.  e.,  due  to  "  eye-strain  " — 
a  term  denoting  morbid  function,  not  over-use  of  nor- 
mal function.  Most  eye-strain  is  due  to  astigmatism, 
but  astigmatism  and  all  its  dependent  ocular  and  gen- 
eral residts  is  not  to  be  corrected  by  the  oculist  whose 
motive  is  fame,  success,  or  money.  It  is  not  corrected 
by  machinery,  or  without  a  mydriatic.  The  work  of 
the  optician  also  conditions  success,  and  recorrection 
is  necessary  every  year  or  tzvo. 

The  trend  of  medical  opinion  may  be  seen  from  a 
recent  editorial  in  the  Lancet  of  August  23,  1902 : 

Chronic  dyspepsia  has  from  time  immemorial  been  one  of 
the  greatest  opprobria  of  medicine.  Judicious  medicinal  and 
dietetic  treatment  relieves  many  of  the  cases,  but  there  are  still 
many  remaining  in  which  all  ordinary  treatment  fails  to  do 


BILIOUSNESS    AND    HEADACHK  i55 

any  permanent  good.  The  immediate  danger  to  life  is  small— 
for  here  we  are  not  speaking  of  malignant  disease— but  exist- 
ence is  a  burden.  Unless  the  greatest  care  is  devoted  to  the 
diet  discomfort  and  pain  will  torment  the  patient  for  hours 
after  a  meal  and  often  relief  will  only  be  obtained  when  the 
stomach  rejects  its  contents.  Sometimes  the  vomiting  may  be 
profuse,  many  pints  being  brought  up.  The  food,  whether 
ejected  or  retained,  fails  to  nourish.  Emaciation,  often 
extreme,  naturally  follows.  The  sufferer,  worn  out  with  pain 
and  weakened  by  lack  of  food,  falls  at  length  into  such  a  state 
that  death  itself  comes  as  a  relief.  Even  when  the  symptoms 
are  not  so  extreme  they  are  sufficient  to  interfere  with  ordi- 
nary life.  The  patient  is  able  to  devote  himself  to  only  a  very 
limited  extent  to  his  work.  He  cannot  forget  his  dyspepsia; 
his  mind  is  centred  in  his  stomach ;  his  diet,  his  beverages,  his 
symptoms  occupy  his  whole  attention  and  he  has  none  to 
devote  to  the  ordinary  concerns  of  life.  Every  medical  man  can 
testify  to  the  correctness  of  this  picture.  Fortunately,  such 
extreme  cases  are  not  very  common,  but  instances  of  a  milder 
type  are  often  met  with,  and  everyone  must  acknowledge  how 
little  relief  is  to  be  expected  from  drugs.  There  are  doubtless 
some  of  these  cases  of  disease  which  are  functional  in  origin 
and  in  which  the  most  minute  examination  of  the  stomach 
and  abdominal  viscera  after  death  cannot  reveal  any  lesion, 
but  these  form  the  exception,  for  in  the  majority  of  cases  a 
necropsy  will  show  some  definite  structural  change  to  which 
may  reasonably  be  attributed  all  the  symptoms.  For  many 
years  a  connexion  between  these  chronic  dyspepsias  and  some 
definite  organic  disease  of  the  stomach  was  hardly  suspected. 
They  were  not  cases  likely  to  be  detained  in  hospitals  for  any 
length  of  time  and  therefore  would  but  rarely  come  to  a 
necropsy,  for  post-mortem  examinations  are  very  exceptional 
outside  hospitals.  But  it  came  gradually  to  be  recognized 
that  in  many  cases  some  definite  structural  change  could  be 
found,  and  now  it  may  confidently  be  laid  down  that  in  the 
vast  majority  of  cases  of  severe  chronic  dyspepsia  the  disease 


156  BIOGRAPHIC    CLINICS. 

is  not  merely  functional  but  has  an  organic  basis.  The  condi- 
tions discovered  on  examination  are  very  various,  but  it  is 
remarkable  that  a  large  proportion  of  them  result  from  the 
healing  of  simple  gastric  ulcers. 

From  which,  I  judge,  the  lessons  should  be  drawn 
that  long-continued  functional  disease  assuredly  begets 
organic  disease;  that  it  behooves  us  to  learn  what 
causes  these  long-continued  functional  diseases;  that 
we  should  seek  to  prevent  the  necessity  of  surgical 
cures  even  if  it  be  true  that  the  surgical  cure  does  in 
fact  cure. 


SOME    NEGLECTED    POINTS    IN 
THE  PHYSIOLOGY  OF  VISION. 


•57 


CHAPTER  VII. 

SOME  NEGLECTED  POINTS  IN  THE   PHYSIOLOGY 
OF   VISION. 

With  all  the  last-century  study  of  the  laws  of  optics 
and  of  the  organ  of  vision,  it  is  strange  that  the  sig- 
nificance of  so  many  ocular  structures  and  functions 
has  been  misconceived  or  neglected.  Most  extensive 
investigations  with  the  keenest  ingenuity  have  been 
made  upon  the  photochemistry  of  the  dead  retina/ 
and  yet  the  important  organs  and  essential  functions 
concerned,  in  the  living  eye,  in  the  avoidance  of  retinal 
exhaustion,  and  the  reinstitution  of  retinal  sensibility, 
have  been  left  almost  unnoticed.  Theories  of  vision 
have  been  elaborated  with  tireless  ingenuity,  and  yet 
the  fundamental  conditions  of  actual  vision  have  not 
been  recognized.  All  the  theories  may  be  left  out  of 
the  attention  if  we  wish  to  fix  upon  the  fundamental 
fact  and  causes  of  retinal  fatigue,  and  the  methods 
and  devices  for  reestablishing  retinal  sensibility.  In 
truth  the  observation  underlying  all  theories  is  that 
the  persistent  action  of  the  light-stimulus  or  image 
upon  one  part  of  the  retina  speedily  lessens  and  extin- 
guishes the  sensation-response.     The  more  intense  the 

^  Epitomized  in  the  "  System  "  of  Morris  and  Oliver,  Vol.  I. 
159 


i6o  BIOGRAPHIC    CLINICS. 

light  the  greater  the  injury,  and  the  quicker  it  is  pro- 
duced. The  reinstatement  of  sensitiveness  is  by  means 
of  shadings,  darkness,  and  variations  of  the  stimulus. 
I  have  seen  no  systematic  and  thoroughgoing  state- 
ment of  the  devices  and  the  methods  whereby  this 
deterioration  of  function  is  prevented,  and  the  resen- 
sitizing  process  is  brought  about.  The  matter  is  of  so 
much  practical  significance  that  they  deserve  enumera- 
tion: 

1.  The  shadows  cast  by  the  retinal  arteries,  veins, 
and  capillaries,  according  to  the  direction  and  intensity 
of  the  entering  light,  are  constantly  shifted  and  modi- 
fied, so  that  the  retina  behind  them  and  in  their  imme- 
diate neighborhood  is  allowed  variations  of  fatigue 
and  recuperation.  The  most  shaded  portions  serve 
perhaps  as  centers  whence  extends  the  mysterious  re- 
sensitizing  process. 

2.  Certain  sensitive  and  trained  eyes,  when  looking 
toward  the  sky  or  a  bank  of  cloud,  can  see  a  multitude 
of  little  lights  like  pin-points  flashing  in  and  out  of 
view  all  over  the  field  of  vision.  These  may  be  re- 
solved into  illuminated  paths  or  lines  of  light,  zigzag- 
ging everywhere  and  appearing  and  disappearing  seem- 
ingly without  law  or  order.  These  have  been  called 
phosphenes,  corpuscular  reflections,  phoses,  and 
aphoses.^     They  are  the  reflections   from  the  blood- 

*  See  an  article  upon  the  subject  in  the  Philadelphia  Medical 
Journal,  July  22,  1899. 


PHYSIOLOGY    OF    VISION.  i6i 

corpuscles  of  the  capillaries  of  the  retina,  which,  as 
they  turn  and  twist  along  their  routes,  act  as  tiny  mir- 
rors to  throw  darting  points  or  traveling  lines  of  light 
upon  all  parts  of  the  retina.  These  multitudes  of  cor- 
puscles also,  of  course,  cast  unobserved  shadows  of 
themselves  upon  the  retina.  The  reflections  may  also 
have  a  function  in  producing  needed  physiologic  irri- 
tation in  parts  of  the  retina  not  habitually  stimulated 
by  the  incoming  light,  and  in  this  way  keeping  it  in  a 
state  of  preparedness  or  responsiveness. 

3.  The  shadows  of  muscse  volitantes  are  probably  of 
greater  service.  Muscae  should  be  recognized  as  of 
physiologic,  not  pathologic,  significance.  They  exist 
in  all  eyes,  although  not  usually  recognized.  Every 
part  of  the  fundus  of  all  eyes  during  the  waking  life 
is  protected  by  these  floating  and  waving  muscae  shad- 
ows. 

4.  The  retinal  pigment  extends  so  far  toward  the 
periphery  of  the  retina  that  functionally  it  joins  that 
of  the  iris  in  preventing  all  light,  except  that  slight 
amount  possibly  transmitted  through  it,  from  entering 
the  interior  of  the  eye  except  through  the  pupil.^ 

^The  strange  tendency  of  xanthelasma  and  other  pigment 
spots  to  appear  upon  the  lids  and  about  the  eyes,  bears  witness 
to  the  difficulty  of  attainment  of  normal  ocular  pigmentation. 
This  is  still  more  striking  in  the  pathologic  dark  rings  or 
half-circles  that  appear  about  the  eyes  of  girls  and  women 
suffering  from  anemia,  chlorosis,  and  other  forms  of  denu- 
trition. 


i62  BIOGRAPHIC    CLINICS. 

5.  The  iris-pigmentation  is  essential  for  retinal  shad- 
ing. The  tragedy  of  albinotic  eyes  is  largely  due  to 
iris-translucency. 

6.  The  alternation  of  contraction  and  dilation  of  the 
pupil  under  ever  varying  light-changes  and  intensities 
varies  the  size  of  the  retinal  image,  and  in  this  way 
adds  another  to  the  agencies  inducing  changes  of  stim- 
uli and  rest. 

7.  The  natural  pigmentation  of  the  skin  in  the  non- 
albinotic  gives  added  exclusion  of  useless  and  harmful 
light  which  passes  more  freely  through  the  eyelid  of 
the  albino. 

8.  The  function  of  the  eyelashes  has  been  supposed 
to  be  the  protection  of  the  eyeball  from  a  striking  body, 
which,  first  touching  the  lashes,  is  followed  by  reflex 
closure  of  the  lids.  I  am  convinced  that  the  lashes  are 
of  little  or  no  service  of  this  kind,  and  that  their  pre- 
dominant use  is  to  screen  the  light  and  shade  the  pupil, 
while  at  the  same  time  allowing  the  passage  of  suffi- 
cient light  to  give  a  useful  image  of  an  object  above 
or  below  the  eye.  The  existence  of  this  function  can 
be  observed  in  others  who  are  standing  in  sunlight,  or 
in  the  photographs  of  sitters  in  open  daylight,  etc. 

9.  Winking  has  been  explained  as  necessary  for 
moistening  and  cleaning  the  cornea,  and  spreading  the 
tears  uniformly  over  the  exposed  surface  of  the  eye. 
It  has  this  function  of  course,  but  another,  fully  as 
important  if  not  more  so,  is  that  of  completely  shutting 


PHYSIOLOGY    OF    VISION.  163 

out  the  entire  retinal  stimulus  for  an  instant  thousands 
of  times  a  day.^ 

10.  Binocular  vision  also  serves  more  than  would 
the  Cyclopean  eye  in  breaking  up  the  continuance  of 
the  stimulus  of  the  retina  upon  any  one  spot. 

11.  Of  greater  importance  than  any  single  one  of 
the  preceding  devices  is  that  of  the  incessant  move- 
ments of  the  eyes,  those  of  the  body  and  head  aiding. 
In  a  child  it  is  almost  impossible  to  secure  any  steady 
fixation  of  the  axis  of  vision,  even  for  a  few  seconds, 
and  the  eyes  of  adults,  when  healthy,  are  thus  held 
with  difficulty  for  only  ten  or  fifteen  seconds  at  most. 
But  the  motionless  stare  of  the  blind  or  highly  ambly- 
opic eye  is  noticed  even  by  the  layman.  This  cease- 
less motion  of  normal  eyes  produces  a  similar  rapid 
variation  of  images,  shadings,  and  rests  of  all  parts 
of  the  retina  in  the  region  of  the  macula.  The  nystag- 
mus of  albinotic  eyes  may  be  defined  as  the  ceaseless 
chase  after  a  portion  of  the  retina  which  may  have 
been  a  little  less  exhausted  than  others  by  the  terrible 
flooding  of  the  entire  retina  with  light. 

12.  The  eyebrow  does,  indeed,  have  the  subordinate 

function  of  leading  water  and  the  sweat  away  from  the 

palpebral  opening,  but  a  more  important  use  of  it  is  to 

shade  the  eye.     A  noteworthy  confirmation  of  this  is 

the  otherwise  inexplicable  growth  of  the  eyebrow  hairs 

^  Many  animals  wink  little  or  not  at  all.  Visual  function  is 
more  perfect  in  man,  and  requires  more  mechanisms  of  shad- 
ing. 


1 64  BIOGRAPHIC    CLINICS. 

in  old  men.  A  striking  example  is  shown  in  the  photo- 
graph of  the  scientist,  Powell,  in  SciencCy  October  lo, 
1902.  I  have  sometimes  had  to  cut  off  these  long 
hairs  in  the  aged  in  order  to  keep  them  from  injuring 
the  eye  by  incurvation  against  the  eyeball.  In  old  age 
the  resensitizing  process  of  the  retina  is  more  difficult 
owing  to  failing  nutrition,  etc.,  and  there  is  a  need  for 
a  still  greater  protection  of  the  pupil  from  the  incident 
light  of  the  sun  and  sky.  This  is  effected  by  the  visor 
of  the  eyebrow  which  at  this  time  of  life  frequently 
takes  on  a  startlingly  luxuriant  growth. 

Some  of  these  minor  devices  doubtless  serve  the  pur- 
pose suggested  only  incidentally,  or  accidentally,  but 
nevertheless  actually,  and  one  must  be  struck  by  the 
fact  that  so  many  different  methods  combine  and  co- 
operate toward  a  common  end.  One  will  scarcely  find 
in  the  entire  organism  such  a  large  number  of 
diverse  mechanisms  focussing  to  one  final  aim  and 
result.  If  the  end  were  not  of  the  supremest  impor- 
tance this  would  hardly  be  permitted.  If  interruption 
of  the  stimulus  were  undesirable,  the  ingenuity  of 
nature  would  have  found  a  dozen  ways  to  prevent  it 
instead  of  as  many  to  encourage  it. 

These  numerous  devices  are,  in  fact,  but  a  very  few 
of  the  many  proofs  of  the  enormous  difficulties  met 
and  conquered  by  nature  in  the  evolution  of  the  eye. 
These  difficulties  are,  apparently,  a  hundred  times  as 
numerous  and  as  complicated  as  those  of  any  other 


PHYSIOLOGY    OF    VISION.  165 

organ  of  the  body.  Hence  the  fineness  of  the  adjust- 
ment, the  ease  with  which  disease  takes  the  place  of 
health,  the  limits  of  normality  being  almost  infinitely 
delicate  and  narrow.  A  glimpse  into  this  amazing 
mystery  is  caught  by  the  observation  that  all  this  di- 
verse mechanism  from  cornea  to  macula  must  be  highly 
transparent,  and  yet  the  greater  portion  is  not  con- 
trolled by  nerve-agencies,  and  all  is  nourished  by  blood 
which  is  scarlet.  And  millions  of  transparent  optic 
nerve  fibers  divested  of  their  insulating  covering  must 
perform  independent  and  accurate  functions! 

The  most  fundamental  of  the  difficulties  of  the  ocu- 
lar mechanic  has  undoubtedly  been  to  create  a  mechan- 
ism that  shall  respond  to  a  stimulus  lasting  but  0.00144 
of  a  second,  and  that  is  hundreds  of  millions  of  millions 
of  times  more  slight  than  that  of  sound.  This  explains 
why  the  receiving  mechanism  or  photographic  plate 
of  the  retina  can  be  kept  sensitive  for  only  a  few  sec- 
onds. In  order  to  resensitize  it  a  change  or  cessation 
of  the  stimulus  must  be  insured  at  least  every  few 
seconds.  Hence  the  elaboration  of  at  least  twelve 
methods  of  insuring  the  result. 

There  are  many  practical  lessons  to  be  derived  from 
the  physiologic  mechanisms  mentioned.  The  almost 
universal  custom  of  wearing  hats,  bonnets,  caps,  etc., 
finds  its  raison  d'etre  in  the  need  of  shading  and  pro- 
tecting— not  the  head  so  much  as  the  eyes.  The  chief 
suggestion  that  arises  is  of  course  the  avoidance  of 


i66  BIOGRAPHIC    CLINICS. 

subjecting  the  eye  to  a  constant  stimulus  or  to  a  harsh 
or  intense  light.  It  is  amazing  what  the  eye  will  en- 
dure when  its  ametropia  is  perfectly  corrected.  It  is 
equally  astonishing  how  easily  a  little  ametropia  mor- 
bidizes  the  whole  bodily  and  nervous  organism.  But 
it  must  be  noted  that  not  even  reading  demands  abso- 
lute uniformity  and  continuance  of  the  image.  There 
is  always  a  gliding  and  changing  of  the  shape  and 
size  of  the  image  by  fluctuations,  interruptions,  shad- 
ings, variations,  etc.  If  our  reading  was  always  by 
means  of  a  consecutive  series  of  letters  each  appear- 
ing for  a  fraction  of  a  second  at  one  and  the  same 
point,  there  would  be  very  little  reading  possible.  But 
even  with  large  print,  and  good  paper  and  ink,  one 
should  not  demand  fixation  of  the  eyes  too  long  at  a 
time.  There  should  be  little  rests  by  closing  the  eyes, 
looking  away,  etc.,  at  least  every  few  minutes.  In  all 
continuous  eye-work  of  any  kind  there  should  be  such 
interruptions.  The  light  should  also  not  be  in  front, 
but  should  illuminate  the  book,  paper,  sewing,  etc., 
from  behind  or  above.  The  book  should  be  held  as 
nearly  on  the  level  of  the  eyes  as  possible.  It  is  a 
pity  that  printing  with  white  ink  on  a  dead  black  sur- 
face is  at  present  an  impossibility. 

When  this  important  law  of  retinal  fatigue  and  re- 
cuperation is  recognized,  there  will  take  place  a  speedy 
revolution  in  almost  all  our  practical  and  esthetic  arts. 
The  furniture,  wall-papers,  carpets,  curtains,  and  win- 


PHYSIOLOGY    OF    VISION.  167 

do.ws  of  our  houses  will  then  be  very  different  from 
what  they  now  are.  Let  us  more  closely  consider  one 
or  two  of  the  many  illustrations. 

It  should  dictate  the  fundamental  tones,  colors, 
shape,  and  extent  of  our  picture-frames.  By  the  old- 
fashioned  gilt  barbarisms  the  artist  allowed  the  framer 
and  gilder  almost  to  monopolize  the  mental,  emotional, 
and  physiologic  attention  of  the  spectator  and  to  de- 
tract as  much  as  possible  from  interest  in  the  picture 
itself.  It  is  only  for  a  few  seconds  that  any  human 
eye  can  look  at  a  picture  when  the  greater  portion  of 
the  retina  is  outraged  and  exhausted  by  the  adjacent 
images  of  the  atrocious  frame.  In  the  ordinary  gal- 
lery of  pictures  these  ludicrous  and  retina-paralyzing 
frames,  close  beside  each  other,  become  positively  tor- 
turing. It  all  seems  designed  to  exhibit,  not  art,  not 
nature,  not  esthetic  charm  and  emotional  peace,  but 
only  the  abject  hideousness  of  the  plebeian  frame- 
gilder's  unart.  Almost  every  traveler  has  noticed  the 
utter  exhaustion  and  headache  that  is  produced  by  a 
short  visit  to  a  large  picture-gallery.  The  crude  harsh 
gilt  is  the  most  wearying  of  all  colors.  Recently  there 
has  arisen  a  reaction  of  which  probably  no  one  under- 
stands the  reason,  consisting  in  the  making  of  frames 
with  solemn  and  monotonous  black.  This  extreme  is 
infinitely  preferable  to  the  other  but  it  is  also  mechan- 
ical and  stupid.  Each  picture  should  be  framed  by 
the  painter,  or  at  least,  and  because  he  has  shown  him- 


1 68  BIOGRAPHIC    CLINICS. 

self  so  blunderful  about  it,  by  another  artist  with  this 
single  task  in  view.  Each  picture  presents  a  special 
problem  to  the  artistic  framer.  It  should  be  done  so 
as  to  produce  a  peculiar,  logical,  and  physiologic  color- 
effect,  as  little  wearying  to  the  eye  as  possible,  while 
dictated  primarily  by  the  character,  the  colors  used, 
the  esthetic  aims,  etc.,  of  the  painter.  It  should  by  all 
means  be  hung  sufficiently  apart  from  all  other  pic- 
tures to  allow  it  the  proper  necessities  of  its  own  indi- 
viduality and  not  to  destroy  that  of  others  hung  in  the 
neighborhood.  Pictures  crowded  together  give  evi- 
dence of  esthetic  sin  quite  as  decidedly  as  the  physical 
crowding  of  human  beings  demonstrates  other  sorts 
of  immorality.  In  a  word,  the  present  fashion  of 
framing  and  hanging  pictures  could  not  be  more  un- 
esthetic  and  anesthetic,  more  unphysiologic  and  patho- 
logic, than  it  is. 

Another  corollary  of  the  law  of  ocular  tire  and  re- 
sensitization  may  be  noticed  in  passing — a  law  that  is 
outraged  by  the  lighting  of  most  of  our  churches,  and 
of  all  of  our  private  houses,  theaters,  public  halls,  etc. 
The  millions  of  dollars  spent  each  year  in  illumination 
are  in  great  part  wasted  and  misspent,  and  by  the 
methods  used  all  the  harm  is  done  to  the  eye  that  is 
possible.  No  room  should  be  lit  in  such  a  manner 
that  the  individual  lights  are  visible.  Illumination 
should  be  by  transmitted,  dissipated,  and  reflected  light.^ 

'See  "Artificial  Illumination,"  by  Dr.  L.  A.  W.  Alleman, 
Brooklyn  Medical  Journal,  December,  1900. 


PHYSIOLOGY    OF    VISION.  169 

There  is  nothing  more  tiring  to  the  eye  than  numerous 
separate  Hghts  whose  images  upon  various  parts  of  the 
retina  create  there  a  large  number  of  useless  and  ex- 
hausting stimuli  and  from  which  there  is  no  escape  by 
and  device  or  turning.  American  oculists  have  so 
many  patients  who,  even  with  the  best  spectacles,  can- 
not escape  suffering  whenever  they  go  to  the  theater, 
opera,  etc.,  that  the  term  "  theater-headache,"  or  "  pan- 
orama headache,"  has  come  into  general  use.  As 
much  as  to  the  character  of  the  sermon  or  of  the  wor- 
shiper, the  famous  sleepiness  of  the  church-goer  was 
due  to  the  somnolence  caused  by  ocular  fatigue  from 
harsh  lights  in  front.  One  of  the  most  common  symp- 
toms of  eye-strain,  known  of  all  oculists,  is  sleepiness 
when  reading  by  artificial  light.  Part  of  this  is  cer- 
tainly due  to  unphysiologic  systems  and  qualities  of 
the  light  used. 


DISCOVERY    OF   ASTIGMATISM 
AND    EYE-STRAIN. 


»7« 


CHAPTER  VIII. 

THE    DISCOVERY    OF    ASTIGMATISM    AND    EYE- 
STRAIN. 

Among  the  many  minds  fused  in  the  personality  of 
Thomas  Young  there  were  those  of  the  physician  and 
the  physicist.  Astigmatism  was  discovered  by  the 
mind  of  the  physicist,  and  great  as  was  the  discovery 
it  is  a  pity  that  it  was  so.  Many  others,  and  inde- 
pendently of  each  other,  soon  rediscovered  the  fact,  so 
that  the  world  would  not  long  have  been  without  the 
knowledge  of  it.  While  we  are  proud  that  we  owe 
the  researches  and  the  memoir,^  "  On  the  Mechanism 
of  the  Eye,"  2  to  a  physician,  the  fact  that  it  sprang 
from  the  intellect  of  the  nonmedical  scientist  is  of  tre- 
mendous significance.  The  optical  and  mechanical 
way  of  looking  at  astigmatism  instituted  by  Young 
was  carried  on  by  Airy,  Bonders,  Helmholtz,  and  their 
successors,  and  is  to-day  the  certain  and  sole  cause 
that  many  millions  of  people  are  needlessly  enduring 
lives  of  intense  suffering  and  wretchedness.  To 
Young  and  to  the  youngest  ophthalmologist,  excepting 

^  Read  before  the  Royal  Society,  November  27,  1801. 

^Thomas  Young:  Philosophical  Transactions,  1793,  p.  169; 
1794,  p.  21;  1795,  p.  i;  see  also  a  "Course  of  Lectures,"  etc., 
1807,  Vol.  2,  p.  575- 

173 


174  BIOGRAPHIC    CLINICS. 

a  relatively  small  number  of  Americans,  the  signifi- 
cance of  astigmatism  has  been  physiologic  instead  of 
pathologic,  has  related  solely  to  optics  and  the  increase 
of  visual  acuity  instead  of  to  disease,  and  the  remote 
effects  of  morbid  physiology.  This  strange  and  fatal 
prepossession  at  once  came  out  in  Airy,  who  discov- 
ered "  abnormal  astigmatism,"  that  is,  "  astigmatism 
that  interfered  with  vision,"  by  which  term  there  was 
an  utter  ignoring  of  the  all-important  truth  that  dis- 
ease is  nothing  more  than  morbid  physiology.  All 
over  the  world  socalled  medical  men  practising  oph- 
thalmology as  a  specialty  have  the  same  conception 
of  the  matter,  and  everywhere  the  ignorant  and  greedy 
optician  is  criminally  allowed  to  pursue  his  calling  of 
using  articles  of  the  materia  medica  (spectacle  lenses) 
which  have  as  powerful  an  influence  in  curing  or  caus- 
ing disease  as  any  other,  except  the  violent  poisons. 

Concerning  Young's  discovery  his  worthy  successor, 
Bonders,^  may  be  quoted : 

The  distinguished  natural  philosopher,  whose  brilliant  merits 
in  the  domain  of  physiologic  optics  were  first  duly  estimated 
by  Helmholtz,  was  himself  nearsighted.  In  relaxation  of  the 
eye,  consequently  in  determination  of  the  farthest  point,  he 
saw  in  his  optometer,  held  in  a  horizontal  position,  the  double 
images  of  the  thread  intersect  one  another  at  seven  inches  from 
the  eye,  on  the  contrary,  at  ten  inches  when  in  a  vertical  posi- 
tion. This  indicates,  on  reducing  the  English  to  Parisian 
inches,  an  astigmatism  of  1/25;  and  it  is,  therefore,  strange 
that  Young,  as  he  himself  remarks,  had  experienced  no  dis- 

^ "  Refraction  of  the  Eye,"  1864,  pp.  456-457- 


ASTIGMATISM    AND    EYE-STRAIN.  i75 

lurbance  from  it.  The  optician,  Gary,  to  whom  Young  com- 
municated his  discovery,  stated  to  him  that  he  had  before 
often  found  that  nearsighted  people  distinguished  objects  much 
more  acutely  when  the  glasses  suited  to  them  were  held  in  a 
particular  oblique  direction  before  the  eye;  now  by  this 
maneuver,  at  least  when  strong  glasses  are  necessary,  a  certain 
degree  of  astigmatism  may  be  corrected.  Young,  too,  had 
already  studied  and  delineated  the  form  of  the  diffusion  spots. 
The  source  of  astigmatism  he  sought  in  the  crystalline  lens, 
because  it  continued  when  he  plunged  his  cornea  into  water 
and  replaced  its  action  by  that  of  a  convex  lens.  He  now 
assumed  an  oblique  position  of  the  crystalline  lens  as  a  cause, 
and  even  thought  that  from  the  diffusion-images  of  a  point  of 
light  it  might  be  deduced  that  the  two  surfaces  of  his  lens 
were  not  centered.  In  a  double  point  of  view,  therefore, 
Young's  eyes  presented  an  exception :  the  refraction  was 
stronger  in  the  horizontal  than  in  the  vertical  meridian,  and 
the  cause  lay  principally  in  the  lens. 

Nagel^  states  that  Gerson,  1810,  described  astigma- 
tism, in  the  inaugural  dissertation  at  Gottingen,  in  the 
eyes  of  Professor  E.  G.  Fischer,  of  Berlin. 

We  hear  nothing  more  concerning  the  subject  until 

1815,  when  in  Vol.  XXVIIL,  "Repertory  of  Arts," 

1816,  Stedman  Whitewell,  an  architect,  describes 
square  shaped  lenses  for  spectacles  in  which  each  side 
is  ground  as  a  cylinder,  with  the  axis  of  one  at  right 
angles  with  that  of  the  other.  No  mention  is  made  of 
the  device  as  regards  the  correction  of  astigmatism. 

In  the  "  Repertory  of  Patent  Inventions  "  for  De- 
cember,   1826,   there   is   an   article   entitled,   *'  On   the 

^  Archiv  f.  Ophth.,  Berlin,  1866,  XII.,  25-30,  "  Historische 
hotz  iiber  Hyperopie  und  Astigmatism." 


176  BIOGRAPHIC    CLINICS. 

means  of  ascertaining  the  true  state  of  the  eyes,  and 
of  enabling  persons  to  supply  themselves  with  spec- 
tacles the  best  adapted  to  their  sight,"  by  John  Isaac 
Hawkins,  Chase  Cottage,  Hamstead  Road,  and  dated 
September  21,  1826.     From  this  I  extract  as  follows: 

I  have,  through  life,  noticed  that  I  could  not  see  so  dis- 
tinctly with  my  right  eye  as  with  my  left,  and  recently  by  the 
use  of  the  optometer  I  have  ascertained  that  the  indistinctness 
is  occasioned  by  the  vertical  focus  of  that  eye  being  greater 
than  the  horizontal  focus,  while  in  the  left  eye  they  are  both  at 
nearly  the  same  distance.  By  vertical  focus  is  meant  the  focus 
of  those  rays  that  enter  the  eye  one  above  the  other;  and  by 
horizontal,  the  focus  of  those  rays  that  enter  the  eye  side  by 
side,  the  difference  no  doubt  arising  from  the  vertical  curvature 
of  the  eye  being  different  from  the  horizontal  which  may  take 
place  either  in  the  cornea  or  front  part  of  the  eye  or  in  the 
crystalline  lens  situated  within  the  eye.  Having  ascertained 
the  average  measurements  of  each  focus  of  my  two  eyes,  I 
contemplate  making  glasses  for  my  right  eye  that  shall  have 
greater  magnifying  power  vertically  than  horizontally;  to 
accomplish  which  I  shall  avail  myself  of  a  plan  patented  in 
France  by  M.  Chamblant,  optician,  of  Paris,  and  make  the  sur- 
faces of  my  glasses  segments  of  cylinders,  one  side  vertical  and 
the  other  horizontal  as  described  in  Dr.  Rees'  encyclopedia 
under  the  article  "  Spectacles." 

In  places  where  an  optometer  cannot  be  procured,  a  book 
ruled  for  music  will  afford  the  means  of  ascertaining  whether 
there  is  any  considerable  difference  between  the  horizontal  and 
vertical  foci  of  the  eyes,  and  of  approximating  toward  an  accu- 
rate measurement  of  them. 

To  measure  the  horizontal  focus  of  the  left  eye,  hold  the 
music  book  with  the  lines  vertical  and  shut  or  cover  the  right 
eye,  move  the  book  nearer  to  and  further  from  the  eye  until 
the  ruled  lines  appear  most  distinctly;  then  measure  the  dis- 
tance from  the  book  to  the  eye  as  before  described. 


ASTIGMATISM    AND    EYE-STRAIN.  i77 

Then  hold  the  music  book  with  the  lines  horizontal  and 
again  move  it  until  the  lines  appear  most  distinctly,  the  dis- 
tance from  the  eye  will  be  the  vertical  focus;  open  the  right 
eye  and  shut  or  cover  the  left  and  proceed  in  the  same  way  to 
ascertain  the  two  foci  of  the  right  eye,  always  recollecting  that 
to  measure  the  horizontal  focus  the  music  lines  must  be  held 
vertically,  and  to  measure  the  vertical  focus  the  music  lines 
must  be  held  horizontally. 

Hawkins  adds  that  these  and  other  observations  in 
the  same  article  are  the  results  of  eighteen  years  of 
experience,  so  that  it  is  probable  that  he  understood 
astigmatism  previous  to  1826. 

The  foregoing  reference  to  Chamblant  may  be  sup- 
plemented by  the  remark  of  Sulzer,^  of  Paris,  who  says 
that  lenses  formed  by  two  equal  cylinders  either  con- 
vex or  concave,  crossing  one  another  at  right  angles, 
were  known  before  1820.  An  article  by  Goode,  pub- 
lished in  1847,  states  that  Chamblant  had  also  ground 
piano-cylinders  and  unequal  crossed  cylinders  that 
were  intended  for  the  correction  of  astigmatism. 

The  next  contribution  upon  the  subject  is  that  of 
Airy,  the  Royal  Astronomer  of  England,  described  in 
the  Transactions  of  the  Cambridge  Philosophical  So- 
ciety, 1827,  Vol.  II.,  p.  267.  We  may  again  conven- 
iently quote  the  abstract  of  Bonders  :^ 

Airy  was  the  first  to  discover  abnormal  astigmatism ;  that 
is,  astigmatism  that  interfered  with  vision,  in  fact,  in  his  own 

^  Annales  d'Oculistique,  1902,  abstracted  in  Annals  of  Oph 
thalmology,  August,    1902. 
"Refraction  of  the  Eye,"  1864,  pp.  510  and  483. 


178  BIOGRAPHIC    CLINICS. 

left  eye.  At  the  same  time  he  conceived  that  a  cylindrical  glass 
might  correct  the  asymmetry,  which  he  actually  found  to  be 
the  case,  the  disturbance  of  vision  being  corrected  by  such  a 
glass.  The  form  of  his  astigmatism  was  the  compound  myopic. 
Airy  conceived  that  if  he  had  two  concave  cylindrical  surfaces 
ground,  with  axes  directed  perpendicularly  to  each  other,  each 
corresponding  to  the  degree  of  myopia  to  be  corrected  in  the 
principal  meridians,  the  object  should  be  attained. 

As  point  of  light  a  small  opening  in  an  opaque  disk  is 
employed,  turned  toward  the  light  of  the  sky,  toward  a  dull 
glass  or  the  globe  of  a  lamp,  and  this  is  moved  along  a  gradu- 
ated scale,  for  example,  that  of  an  optometer.  We  then  find  a 
greatest  distance  at  which  the  point  of  light  appears  as  the 
most  slender  line,  and  a  shortest  distance  at  which  it  again 
becomes  a  thin  line,  perpendicular  to  the  first.  The  distances 
then  give  about  the  degrees  of  myopia  in  the  principal  merid- 
ians.i 

According  to  Lawrence^  the  lenses  by  which  Airy 
corrected  his  own  astigmatism  were  ground  by  Fuller 
at  Ipswich  (London  Medical  Gazette,  Vol.  I.,  p.  134). 

The  term  astigmatism  was  first  used  by  Rev.  Dr. 
Whewell  to  designate  the  defect  described  by  Airy. 

In  the  American  Journal  of  the  Medical  Sciences  for 
April,  1872,  N.  S.,  Vol.  LXIIL,  pp.  355-359,  there  is  a 
note  respecting  the  first  recorded  case  of  astigmatism 
in  America  for  which  cylindric  lenses  were  made,  con- 

^The  theory  of  refraction  by  asymmetrical  surfaces  was 
developed  by  Sturm  (Comptes  rendus  de  I'Academie  des  Sci- 
ences de  Paris,  t.  XX.,  pp.  554,  761,  1238,  and  Poggendorif's 
Annalen,  B.  65,  116).  (Compare  with  Fich,  "  Mediz.  Physik," 
p.  327.) 

2  "Diseases  of  the  Eye,"  Am.  ed.  by  Hays,  1854,  p.  669. 


ASTIGMATISM   AND    EYE-STRAIN.  I79 

tributed    by    Dr.    Henry    D.    Noyes,    of    New    York. 
From  this  the  following  extracts  are  made: 

By  the  kindness  of  Dr.  Gray,  of  the  New  York  State 
Lunatic  Asylum,  Utica,  I  have  come  in  possession  of  a  pair  of 
cylindrical  glasses  which  I  suppose  were  the  first  ever  made  in 
this  country.  They  belonged  to  Rev.  Mr.  Goodrich,  who  at  the 
time  of  his  death  was  chaplain  of  the  asylum.  They  were  given 
to  me  wrapped  in  a  piece  of  writing  paper  on  which,  in  the 
owner's  handwriting,  was  inscribed  the  following  memoran- 
dum :  "  No.  7  French  No.  (number)  cylinder,  con.  got  of 
McAllister  May,  1828.  I  wrote  fourteen  months,  t.  e.,  till  July, 
1829.  Again  put  into  use  March  11,  1843;  they  were  laid  aside 
December   10,   1850." 

The  glasses  are  plano-concave  cylinders  of  seven  inches  focus 
with  axes  horizontal  and  were  mounted  in  a  spectacle  frame 
with  oval  eyes.  The  maker  is  the  old  and  well-known  optician, 
Mr.  John  McAllister,  of  Philadelphia. 

The  following  is  extracted  from  the  account  given 
by  Mr.  Goodrich  himself: 

From  my  earliest  years  I  have  been  sensible  of  a  defi- 
ciency in  sight  which  I  was  induced  to  call  nearsightedness 
because  I  was  obliged  to  approach  nearer  to  objects  to  see 
them  than  most  persons,  which  is  still  the  case.  This  defic- 
iency until  I  was  about  sixteen  years  of  age  was  accompanied 
with  weakness  of  sight,  but  my  eyes  are  now  strong.  I  com- 
menced my  studies  regularly  at  the  age  of  nineteen  and  am  now 
twenty-four.  Close  study  has  had  no  other  effect  upon  my 
sight  than  to  strengthen  its  endurance  but  not  its  precision  or 
length.  My  right  eye  is  and  always  has  been  much  better  than 
my  left,  but  the  defect  in  both  is  precisely  of  the  same  nature. 
At  the  age  of  sixteen  I  procured  a  pair  of  plain  green  glasses, 
which  were  some  little  assistance  in  moderating  the  intensity 
of  the  light.  I  tried  to  get  concave  glasses,  but  could  find  none 
that  were  of  any  essential  assistance.    I  afterward  used  a  small 


i8o  BIOGRAPHIC    CLINICS. 

convex  lens  of  about  ten  inches  focal  distance,  as  a  microscope, 
to  assist  me  in  reading,  which  was  some  assistance,  but  during 
the  five  years  of  studying  I  have  used  no  glasses  whatever.  In 
November  last  (1825)  I  procured  a  pair  of  concave  glasses  in 
New  York,  about  five  or  six,  which  will  accompany  this  letter. 
Until  then  I  had  never  discovered  that  a  change  of  position 
had  any  influence  on  my  sight,  but  in  looking  through  these 
glasses  I  found  that  any  object  whose  length  is  in  a  horizontal 
direction  appears  much  more  distinct  than  a  similar  object 
whose  length  is  perpendicular  to  the  plane  of  the  horizon. 
Thus  the  cross-rigging  of  a  ship  appears  much  more  distinct 
than  the  mast  and  perpendicular  ropes.  I  have  since  been  led 
to  make  experiments  first  on  the  naked  eye,  then  on  it  in  con- 
nection with  my  glass,  which  I  send  you,  and  the  result  at 
which  I  have  arrived  has  been  universally  the  same.  These 
facts  [experiments  and  diagram  of  Goodrich  omitted]  would 
lead  me  to  conclude  that  the  crystalline  lens  of  my  eye  is  cylin- 
drically  convex  or,  perhaps,  oblately  convex,  and  that  its  great- 
est length  is  in  a  perpendicular  direction  (that  is,  in  a  line 
parallel  with  the  length  of  my  body)  ;  consequently  I  would 
conclude  that  a  glass  whose  shape  resembled  the  probable  shape 
of  the  crystalline  lens  of  my  eye,  placed  before  my  eye  so  that 
its  greatest  length  would  be  at  right  angles  with  the  lens  of 
my  eye,  would  produce  a  perfect  image.  If  it  be  true  that  my 
eye  requires  a  glass  whose  shape  does  not  correspond  to  a  por- 
tion of  a  true  sphere,  but  rather  to  a  portion  of  a  spheroid  or, 
perhaps,  a  cylindric,  I  cannot  tell  from  any  observations  I  have 
yet  made  on  my  eyes,  whether  the  glasses  should  be  of  the  con- 
cave or  convex  form.  The  great  difficulty  is  why  should  the 
appearance  of  objects  be  entirely  changed  by  the  interposition 
of  a  concave  glass?  When  I  purchased  my  glasses  I  was  not 
aware  of  this  curious  fact  in  regard  to  my  eyes  either  with  or 
without  glasses.  I  only  knew  that  I  got  those  through  which, 
on  the  whole,  I  could  see  best.  If  it  be  asked  whether  I  con- 
sider the  glasses  in  question  are  essential  assistance  to  my 
sight,  I  answer  that  if  my  object  be  to  examine  a  horizontal 


ASTIGMATISM   AND    EYE-STRAIN.  i8i 

object,  they  truly  are  assistance  and  they  are  so  in  the  exami- 
nation of  a  perpendicular  one,  provided  I  turn  my  head  at  a 
right  angle.^ 

Leuff-  determined  the  radius  of  curvature  of  one 
cornea  in  the  vertical  and  horizontal  meridian. 

Wharton  Jones^  and  Wilde*  assume  that  the  founda- 
tion of  astigmatism  is  really  to  be  sought  in  the  cornea 
and  that  the  cornea  in  its  vertical  meridian  has  a 
shorter  radius  of  curvature  than  in  the  horizontal  and 
they  explain  Airy's  case  by  a  peculiar  development  of 
that  difference. 

Hamilton^  reports  a  case  of  abnormal  astigmatism 
in  1847. 

Dr.  Goode^  described  astigmatism  in  his  own  eyes 
and  those  of  three  other  gentlemen  in  the  University 
of  Cambridge  in  1848. 

Stokes'  invented  the  astigmatic  lens  for  determin- 

^  In  Lawrence's  "  Diseases  of  the  Eye,"  1854,  p.  669,  two 
other  cases  corrected  for  him  by  McAllister  in  Philadelphia  in 
1853  are  described  by  Hay. 

2Conf.  Volkmann,  "Art.  Sehen,"  p.  271,  in  Wagner's 
"  Handworterbuch  der  Physiologie,"  1846. 

^ "  Manual  of  Ophthalmic  Medicine  and  Surgery,"  second 
edition,  London,  1855,  p.  352. 

* "  Dublin  Journal  of  Medical  Science,  First  series,  Vol. 
XXVIII,  p.  105. 

^Monthly  Journal  of  Medical  Science,  Edinburgh,  1847,  p. 
891. 

^Monthly  Journal  of  Medical  Science,  Edinburgh,  1848,  p. 
711,  and  Transactions  of  the  Cambridge  Philosophical  Society, 
Vol.  VIIL,  p.  493. 

^  "  Report  of  the  British  Association  for  the  Advancement  of 
Science"  for  1849,  p.  10. 


i82  BIOGRAPHIC    CLINICS. 

ing  the  degree  of  astigmatism  in  1849.  This  consisted 
of  two  cyUndrical  lenses,  the  one  plano-convex  of  yV> 
the  other  plano-concave  of  xV-  These  are  fastened  in 
copper  rings  .which  are  fitted  into  one  another  and  can 
turn  past  one  another  around  their  axis.  The  lenses 
rotate  past  one  another,  at  the  same  time  their  flat 
surfaces  being  toward  each  other.  The  degree  of 
astigmatism  is  ascertained  by  an  index  and  scale  on  the 
rings. 

Pastor  Schnyder,  according  to  Bonders,^  of  Meuz- 
burg,  discovered  astigmatism  in  his  own  person.^ 

In  1855  Helmholtz  confirmed  previous  findings  as  to 
the  ellipsoidal  nature  of  the  cornea,  and  in  i860  Bon- 
ders brought  the  matter  to  a  full  and  complete  scien- 
tific statement. 

An  important  factor  of  progress  was  now  supplied 
by  an  American,  Dr.  Ezra  Dyer,  who,  after  extensive 
studies  abroad,  returned  to  Philadelphia  in  1861  to 
practise  ophthalmology.  He  was  the  first,  I  think,  to 
perfect  the  methods  of  accurate  and  scientific  diagnosis 
of  astigmatism,  and  its  relief  by  spectacles,  as  a  daily 
clinical  practice.  I  cannot  learn  that  Dyer  had  any 
intellectual  conception  of  the  pathologic  significance 
of  his  work.  That  honor  is  reserved  for  Mitchell  and 
for  other  Philadelphia  specialists  in  diseases  of  the 

^ "  Refraction  of  the  Eye,"  1864,  p.  542. 

M«n.  d'Oculistique,  t.  XXI.,  p.  222,  Bruxelles,  1849,  taken 
from  the  "  Verhandlungen  der  Schweizerischen  Naturfor- 
schenden  Gesellschaft." 


ASTIGMATISM    AND    EYE-STRAIN.  183 

eye.  Dyer's  great  service  was  that  he  first  as  routine 
practice  did  honest  and  scientific  work  in  refraction. 
The  results  soon  showed  that  patients  were  at  once 
and  unexpectedly  relieved  of  their  previous  headaches 
and  other  sufferings.^  The  systemic  effects  of  the 
neutralization  of  ametropia  by  glasses  were  almost 
magical,  and  immediately  a  number  of  keen-minded 
physicians  caught  the  truth  and  began  their  successful 
life-work  as  refractionists.  These  were  Doctors 
Thomson,  Norris,  Harlan,  Hay,  Morton,  Risley,  and 
others. 

The  house  of  Queen  &  Co.  began  filling  prescrip- 
tions for  cylinders  in  1874,  the  order  of  the  first  ones 
being  signed  by  Norris,  Thomson,  Thomson,  Norris, 
Norris,  Risley,  etc.,  respectively. 

Dyer  first  put  into  use  the  test  types  previously  sug- 
gested by  Snellen,  and  which  in  the  United  States  were 
called  "  Dyer's  Types,"  or  "  Dyer's  Test  Letters." 

In  1863  Dr.  Hasket  Derby,  of  Boston,  reported^ 
four  cases  of  astigmatism,  the  correcting  cylinders 
being  ground  by  Paetz  and  Flohr,  of  Berlin.  The 
first  examination  for  astigmatism  and  prescription  of 

^  Dyer  first  sent  his  prescriptions  for  cylinders  abroad  to  be 
filled,  but  in  1862  or  1863  the  Philadelphia  optician,  Zentmayer, 
was  able  to  fill  them.  According  to  Bumstead  (Atn.  Med. 
Times,  1863,  VIL,  pp.  203-205)  cylinders  were  ground  by  Paetz 
and  Flohr  in  Berlin,  and  by  Natchet  in  Paris.  In  the  same 
article  Dyer's  test  types  are  described. 

Mw.  Med,  Times,  1863,  VIL,  pp.  277-278. 


i84  BIOGRAPHIC    CLINICS. 

cylindrical  lenses  in  Boston  was  one  of  these  cases,  and 
was  made  by  Derby  on  May  12,  1862.  The  patient 
was  still  living  on  September  30,  1902. 

Dr.  G.  Hay  described  a  case  of  astigmatism  in  the 
Boston  Medical  and  Surgical  Journal,  1867,  LXXV., 

pp.  513-515. 

Dr.  John  Green,^  in  1867,  wrote  a  paper  on  astig- 
matism as  an  active  cause  of  myopia. 

Dr.  O.  M.  Pray  described  his  test  type  for  the  diag- 
nosis of  astigmatism  in  1869.^ 

Dr.  Mills  reported  a  case  of  compound  myopic  astig- 
matism in  the  service  of  Dr.  Harlan  in  Wills  Hospital 
in  1871.^ 

But  up  to  this  time  there  had  been  no  word  or  hin/" 
that  astigmatism  had  any  pathologic  significance. 
With  all  these  investigators  it  had  been  solely  a  matter 
of  physiology,  of  optics,  mechanic  or  physiologic,  re- 
ferring at  best  only  to  visual  acuteness.  Now,  how- 
ever, arose  a  man,  an  American,  Dr.  S.  Weir  Mitchell, 
who  must  be  recognized  as  one  of  the  greatest  medical 
discoverers  and  benefactors  of  the  race.  So  far  as  I 
can  learn  he  first  taught  the  pathologic  significance  of 
astigmatism  and  eye-strain,  and  that  the  prescription 
of  cylindric  lenses  is  of  vast  importance  in  the  cure  and 
prevention  of  systemic  diseases. 

"■Arch.  Ophth.  and  Otol,  1869,  I.,  No.  i,  pp.  17-21. 
^  Am.  Jour.  Med.  Sci.,  January,  1867. 
'  Phila.  Med.  Times,  1871,  II.,  p.  70. 


ASTIGMATISM   AND    EYE-STRAIN.  185 

Nothing  that  our  distinguished  colleague  has  ever 
contributed  to  medical  progress  can  equal  the  value  of 
that  of  the  masterly  articles  which  he  wrote  in  1874, 
1875  and  1876  upon  the  subject  of  eye-strain.  The 
first  was  entitled  ''  Headaches  from  Heat-strokes,  from 
Fevers,  after  Meningitis,  from  Overuse  of  the  Brain, 
from  Eye-strain."^  The  second  was  called  "  Notes  on 
Headache,"^  and  the  third  "Headaches  from  Eye- 
strain."^ The  last  article  is  a  recapitulation  and  com- 
pletion of  the  data  and  conclusions  set  forth  in  the 
first  two,  and  from  it  I  make  the  following  quotations : 

My  consultations  have  plainly  enough  taught  me  that  hardly 
any  men  in  the  general  profession  are  fully  alive  to  the  need 
of  interrogating  the  eye  for  answers  to  some  of  the  hard 
questions  which  are  put  to  us  by  certain  head  symptoms,  since 
many  of  the  patients  treated  successfully  by  the  correction  of 
optical  defects  never  so  much  as  suspected  that  their  eyes  were 
imperfect.  What  I  desire,  therefore,  to  make  clear  to  the  pro- 
fession at  large  is : 

1.  That  there  are  many  headaches  which  are  due  indirectly 
to  disorders  of  the  refractive  or  accommodative  apparatus  of 
the  eye. 

2.  That  in  these  instances  the  brain  symptom  is  often  the 
most  prominent  and  sometimes  the  sole  prominent  symptom 
of  the  eye  troubles,  so  that,  while  there  may  be  no  pain  or 
sense  of  fatigue  in  the  eye,  the  strain  with  which  it  is  used  may 
be  interpreted  solely  by  occipital  or  frontal  headache. 

^Medical  and  Surgical  Reporter,  July  25,  1874,  and  August  i, 
1874 
^  Ibid.,  February  6,  1875. 

'  Am.  Jour.  Med.  Set.,  April,  1876,  pp.  363-373. 
»3 


1 86  BIOGRAPHIC    CLINICS. 

3.  That  the  long  continuance  of  eye  troubles  may  be  the 
unsuspected  source  of  insomnia,  vertigo,  nausea,  and  general 
failure  of  health. 

4.  That  in  many  cases  the  eye  trouble  becomes  suddenly 
mischievous  owing  to  some  failure  of  the  general  health,  or  to 
increased  sensitiveness  of  brain  from  moral  or  mental  causes. 

In  seeking  to  prove  these  propositions  I  shall  use  some  of 
the  cases  which  I  have  already  given  in  the  Reporter,  and 
others  which  I  have  since  seen,  or  which  have  been  put  at  my 
disposal  by  friends  who  are  engaged  in  the  practice  of  oph- 
thalmic surgery. 

I  may  here  remark  that  the  books  on  diseases  of  the  eye 
scarcely  more  than  allude  to  the  distressing  cerebral  symptoms 
of  which  I  have  spoken,  except  when  discussing  the  subject  of 
accommodative  asthenopia  from  hypermetropia.  Yet  in  prac- 
tice almost  all  of  the  extreme  refractive  or  accommodative  eye 
troubles  give  rise,  in  a  certain  proportion  of  people,  to  these 
symptoms,  while  in  those  congenitally  sensitive,  or  who  become 
so  in  after-life,  even  slight  optical  defects,  especially  when 
unequally  developed  in  the  two  eyes,  may  also  give  rise  to  like 
annoyances. 

I  have  certainly  seen  cases  in  which  the  form  of  headache 
caused  by  eye  troubles  was  a  pure  migraine  or  hemicrania,  but 
this  I  believe  to  be  rare;  while  I  am  sure  also  that  in  many 
persons  who  are  already  the  victims  of  migraine  it  has  been 
made  worse  and  more  frequent  by  the  over-use  of  defective 
eyes,  as,  indeed,  it  may  be  from  any  cause  of  exhaustion,  and 
has  again  been  lessened  in  severity  and  as  to  number  of 
attacks  by  proper  correction  of  the  eye  disorder.  Dr.  Liveing, 
in  his  interesting  and  thoughtful  work  on  sick-headache  (t.  e., 
megrim)  states  that  M.  Piorry  long  ago  described  megrim  as 
capable  of  being  caused  in  those  with  weak  eyes  by  straining 
at  near  or  minute  objects,  and  this  is  doubtless  the  case;  but 
the  form  of  head-pain,  to  which  I  am  about  to  refer,  is  cer- 
tainly not,  as  a  rule,  of  the  nature  of  megrim,  and  as  soon  as 


ASTIGMATISM   AND    EYE-STRAIN.  187 

it  disappears  when  the  eyes  are  corrected,  is  lacking,  happily, 
in  the  obstinacy  of  that  distressing  malady. 

The  following  cases  fairly  illustrate  the  first  two  of  the 
propositions  I  have  stated  above.  First  of  these  I  put  the  fol- 
lowing case,  because  it  was  the  one  which  earliest  opened  my 
eyes  on  this  subject.  My  tardy  knowledge  certainly  cost  my 
patient  a  long  period  of  unrelieved  distress : 

Case  I. — Mr.  E.,  a  prominent  merchant,  consulted  me  for 
pain  in  the  upper  spine  and  occiput.  It  increased  day  by  day 
every  winter,  and  left  him  during  the  summer,  which  was 
spent  in  shooting  and  fishing — a  tent  life,  in  fact.  Mr.  B.  was 
even  cauterized  in  New  York  for  these  pains,  and  here  at  home 
he  had  much  able  advice  beside  my  own.  When  I  first  saw 
him  I  was  thoroughly  misled.  It  was  late  in  the  winter,  and, 
as  usual,  while  in  the  autumn  only  writing  at  first,  and  then 
later  reading,  and  then  any  near  work,  caused  pain;  as  time 
went  by  there  came  a  period  when  all  mental  labor,  when 
excitement,  motion,  or  any  thought  caused  pain.  He  was  in 
this  over-sensitive  state  when  I  saw  him,  and  was  aided  by 
nothing  I  did.  His  holiday  cured  his  head,  and  on  his  return 
some  friends,  I  believe,  suggested  to  him  that  his  eyes  might 
be  weak,  and  with  this  idea  he  consulted  Dr.  William  Thom- 
son, who  gave  me  the  following  additional  particulars  from  his 
notebook : 

"Writing  had  become  so  distressing  to  this  gentleman,  that 
for  a  year  past  all  letters  have  been  written  by  a  secretary,  at 
his  dictation.  He  states  that  a  few  moments  spent  in  writing 
give  him  a  creeping  sensation  up  the  spine  and  through  the 
back  part  of  the  head,  followed  by  giddiness  and  severe  pain,  so 
urgent  as  to  render  him  fearful  of  a  '  fit  of  some  kind.'  .  .  . 
His  compound  hyperopic  astigmatism  was  corrected,  and  on 
using  the  glasses  habitually,  his  distressing  symptoms  quickly 
disappeared.  He  has  long  since  forgotten  his  apprehensions  of 
an  impending  apoplexy  or  epilepsy;  he  can  see  as  sharply  as 
any  of  his  companions,  and  he  can  use  his  eyes  continuously  in 
reading,  writing,  or  any  near  work." 


1 88  BIOGRAPHIC    CLINICS. 

Relief  in  this  case  followed  at  once  the  use  of 
glasses,  which  proved  competent  without  other  means 
to  conduct  him  to  perfect  and  useful  health  again. 

The  following  case  will  answer  to  show  how  pro- 
foundly the  whole  system  may  be  perturbed  by  an 
ocular  defect : 

Case  II. — Miss  J.,  an  accomplished  and  energetic  single 
lady,  aged  30,  from  New  Jersey,  having  the  care  of  a  sick 
mother  and  of  a  household,  began  some  five  years  ago  to  have 
evening  headaches,  pain  in  the  back  of  the  head  and  neck,  sense 
of  extreme  fatigue  and  violent  flushing  if  she  persisted  in 
exerting  her  mind  in  writing  or  reading.  Unfortunately,  a 
portion  of  her  income  and  much  of  her  pleasure  in  life 
depended  upon  her  ability  to  write,  so  that  for  a  long  time  she 
continued  to  do  so,  despite  the  increase  of  all  her  troubles. 
When  at  last  she  came  to  me,  a  feeble,  nervous,  anemic 
woman,  sleeping  little  and  cursed  with  headache  almost  con- 
stantly, I  confess  that  for  nearly  two  years  while  I  saw  her  at 
intervals,  I  looked  everywhere  but  to  her  eyes  for  the  cause 
of  the  mischief.  At  length,  after  a  most  unsatisfactory  winter 
of  rest  from  work,  freedom  from  care  and  many  tonics,  I  made 
a  more  careful  study  of  her  eyes,  and  having  grown  sure  that 
they  were  imperfect,  asked  her  to  consult  an  ophthalmic  sur- 
geon. At  this  time  the  use  of  the  eyes  brought  about  pain  in 
them  and  sense  of  fatigue,  whereas  at  first  the  headaches, 
which  came  only  after  long  use  of  the  eyes  were,  as  I  have 
said,  unaccompanied  by  any  sense  of  trouble  in  the  eyes.  Her 
compound  hyperopic  astigmatism  was  corrected  (by  Dr. 
Thomson)  and  she  was  seen  again  May  26.  Headache  has 
disappeared,  sleeplessness  has  vanished;  she  can  read  and 
write  without  pain,  and  she  uses  her  glasses  constantly.  In 
October  this  lady  was  seen  again,  and  pronounced  herself  long 
since  relieved  and  able  to  use  her  eyes  constantly,  with  the 
correction,  in  all  near  work. 


ASTIGMATISM   AND    EYE-STRAIN.  189 

I  myself  saw  this  lady  anew  this  autumn.  The  change  in 
her  appearance  was  remarkable,  and  was,  I  think,  solely  due 
to  relief  of  the  strain  with  which  she  used  her  eyes.  The 
headache  left  early,  and  with  it  the  sleeplessness.  Once  able 
to  slumber  and  to  get  rest,  the  body  swiftly  repaired  damages, 
and  the  anemia  also  departing,  a  general  gain  in  flesh,  color 
and  strength  were  the  results. 

Another  patient  (corrected  by  Dr.  Thomson)  reports  her- 
self as  perfectly  comfortable,  and  only  distressed  at  the  loss  of 
16  years  of  useful  life,  and  now  able  to  read  or  sew  as  much  as 
she  wishes. 

The  cases  j  ust  told  seem  to  me  enough  to  prove  that  the  eyes 
may  long  rest  unsuspected  as  the  cause  of  headache,  and  of 
other  intracranial  distresses  and  disorders.  Case  II.  is  the 
more  remarkable  of  those  which  illustrate  this  fact,  because 
when  attending  this  lady  I  was  already  on  my  guard  as  to  this 
cause  of  headache,  and  yet  was  for  a  long  time  altogether  mis- 
led. Who,  indeed,  could  have  supposed  that  a  mere  ocular 
defect  could  have  given  rise  to  so  serious  a  train  of  evils — 
beginning  with  headache  and  ending  with  unconquerable 
anemia — and  who  that  had  not  seen  it  could  believe  that  the 
correction  by  glasses  of  the  eye  trouble  could  have  given  a 
relief  so  speedy  and  so  perfect  that  she  herself  described  it  as 
a  miracle. 

Case  V.  was  that  of  a  woman  of  27,  who  had  nervous  and 
spinal  troubles,  frequent  headaches,  and  prolonged  hysterical 
states.  Dr.  Wm.  F.  Norris,  to  whom  she  was  sent,  corrected 
her  astigmatism,  compound  myopic  in  one  eye,  and  compound 
hypermetropic  in  the  other,  and  the  relief  given  in  the  case  was 
almost  immediate,  but  some  time  elapsed  before  the  headaches 
were  entirely  lost. 

Dr.  Wm.  F.  Norris  sends  me  the  following  very  striking 
case  of  hypermetropic  astigmatism  in  which  there  was  no  eye 
pain,  but  violent  headache,  described  as  neuralgic,  with  nausea 
and  vomiting.  The  relief  given  by  glasses  was  absolute  and 
abrupt. 


I90  BIOGRAPHIC    CLINICS. 

The  third  proposition,  to  the  effect  that  vertigo  of  most 
alarming  character,  as  well  as  other  intracranial  symptoms, 
may  be  the  chief  expression  of  eye  lesions,  is  illustrated  by  the 
following  cases : 

Case  VIII. — Miss  B.,  aged  i6,  was  well  until  her  periods 
began,  and  these  being  copious,  she  found  that  for  several  days 
afterward  she  had  headaches  which  came  only  upon  use  of  the 
eyes  and  were  less  grave  as  the  month  of  interval  passed  by. 
I  suspected  the  cause,  and,  in  fact,  learned  that  she  had  un- 
equally myopic  eyes.  I  advised  that  these  should  be  corrected, 
but  as  her  family  physician  insisted  that  she  must  have  had 
the  eye  lesion  always,  and  could,  therefore,  not  be  suffering 
suddenly  from  what  had  always  been  present — she  was  easily 
persuaded  to  yield  to  her  own  dislike  of  glasses,  and  so  noth- 
ing was  done  save  only  to  strive  to  lessen  the  menstrual  flow. 

After  a  year  more  she  came  back  to  me  with  an  addition  to 
her  symptoms  of  occasional  unsteadiness  of  gait,  with  a  sudden 
sense  of  terror  and  vertigo.  The  headaches  were  no  better.  In 
a  half-conscious  self-defence  she  had  given  up  sewing  and 
writing  and  read  little,  yet  still  the  headaches  continued 
because  she  had  now  reached  that  advanced  stage  of  sensitive- 
ness in  which  the  ordinary  every-day  use  of  the  eyes  was  hurt- 
ful. Of  late,  too,  her  rest  was  broken  and  disturbed  by 
dreams.  Meanwhile,  also,  she  had  been  reexamined,  and  by 
the  aid  of  the  ophthalmoscope  discovered  to  have  cerebral 
anemia,  because,  as  I  was  told,  the  headaches  went  away  in  the 
night,  when,  owing  to  her  prone  position,  more  blood  went  to 
the  head. 

The  ophthalmoscope  is  just  now  where  the  stethoscope  was 
forty  years  ago,  and  is  called  upon  to  do  things  which  I  do  not 
think  it  can  do,  so  that  I  am  grown  a  little  suspicious  of  state- 
ments as  to  diagnosing  by  the  eye-ground  vessels  the  amount 
of  blood  in  the  head.  Save  only  in  the  case  of  gross  lesions  the 
value  of  the  ophthalmoscope  has  been  overrated.  I,  at  least, 
am  unable  to  diagnose  slight  degrees  of  cerebral  anemia  from 
the  state  of  the  vessels  of  the  disk, 


ASTIGMATISM   AND    EYE-STRAIN.  191 

My  patient  had  been  endlessly  treated  with  tonics,  but  some- 
how none  did  any  good,  and  she  was  surely  hastening  toward 
a  course  of  uterine  treatment,  the  usual  goal  in  difficult  cases 
of  obscure  disease  in  women.  At  this  time  I  urged  her  to 
travel  in  Europe,  and  while  there  to  have  her  eyes  corrected. 
She  took  the  agreeable  part  of  my  advice,  but  gaining  little 
from  a  few  months  of  too  rapid  and  wearying  travel,  again 
wrote  to  complain  of  increasing  headaches  and  of  more  fre- 
quent spells  of  ocular  vertigo.  I  could  only  urge  anew  the 
correction  of  the  eyes,  especially  since  she  had  improved  in 
color  and  as  to  gain  of  flesh,  with  no  like  bettering  of  the 
cephalic  troubles.  This  time  she  took  my  advice  and  was  per- 
suaded to  wear  her  glasses  steadily.  At  first  the  vertigo  grew 
worse,  but  soon  it  and  the  headaches  and  the  insomnia  passed 
away,  so  that  in  a  month  she  was  able  to  sew,  write,  or  read  for 
hours  at  a  time. 

This  briefly-told  case  is  somewhat  instructive,  but  I  have 
given  it  chiefly  because  of  the  vertigo,  which  is  seen  in  some 
instances,  but  which  few  physicians  would  suspect  to  be  due  to 
troubles  in  the  eye;  nevertheless,  I  have  learned  to  look  to  it 
as  one  source  of  the  symptom  vertigo.  There  is  an  ocular 
vertigo  as  well  as  an  aural  vertigo,  and  I  believe  that  I  have 
seen  it  under  three  sets  of  conditions.  Thus  it  is  sometimes 
caused  by  a  sudden  lessening  of  intraocular  pressure,  but  is 
more  often  seen  in  cases  of  disorder  of  the  accommodative,  or 
of  the  extraocular  muscles;  being  after  all  neither  so  common 
nor  so  easily  caused  as  the  analogue,  aural  vertigo.  Usually, 
indeed,  it  comes  only  after  the  eye  trouble  and  some  other 
cause  of  general  weakness  have  made  the  intracranial  circula- 
tion unstable.  Occasionally,  as  I  believe  the  oculists  know,  a 
dose  of  atropia  used  in  one  eye  will  bring  it  suddenly;  and  this 
is  more  notably  seen  in  persons  whose  balancing  power  is 
already  affected  by  posterior  spinal  sclerosis  or  by  cerebellar 
growths.  Perhaps  the  most  important,  because  the  most  mis- 
leading point  in  all  of  this  subject,  is  the  fact  that  such  as  are 
in  sturdy  health  are  often  able  for  years  to  overcome,  without 


192  BIOGRAPHIC    CLINICS. 

sense  of  strain,  muscular  difficulties  in  binocular  accommoda- 
tion, and  to  endure  unharmed  astigmatism  with  accommodative 
troubles.  But  with  increase  of  years  their  powers  fail,  and 
they  begin  to  feel  the  added  exertion  now  needed  in  some 
shape — either  in  eye  or  head,  or  in  both.  Or  else  it  chances 
that  to  one  of  these  people  comes  an  attack  of  illness,  a  moral 
or  emotional  strain,  or  a  time  of  overwork  with  worry,  when 
at  once  the  eye  trouble  leaps  into  mischievous  prominence,  and 
once  felt  is  felt  through  all  the  future  more  and  more  by  a 
brain  which,  in  the  language  of  the  photographer,  I  might  aptly 
describe  as  having  become  oversensitized.  I  have  seen  in  my 
practice  or  in  that  of  others  examples  of  this  sequence. 

I  must  now,  I  think,  have  amply  illustrated  the  fact  that  eye- 
strain causes  headache  and  worse  disorders,  and  is  often  their 
unsuspected  cause.  Simple  deficiency  of  power  in  one  internal 
rectus  muscle,  if  extreme,  results  in  the  patient  being  so  utterly 
unable  to  overcome  it  as  to  give  up  the  effort  and  allow  the  eye 
to  roll  out,  contenting  himself  with  clear  monocular  vision. 
The  effort  needed  to  overcome  lesser  weakness  is  a  competent 
one,  but  ends  in  incessant  exertion  and  fatigue.  The  accommo- 
dative effort  needed  in  hypermetropia,  especially  with  astig- 
matic trouble,  is  extreme,  owing  to  the  instinctive  and  never- 
satisfied  craving  for  distinct  vision,  and  hence  the  source  of 
fatigue.  I  presume  that  the  strain  made  on  the  eye  by  these 
various  forms  of  trouble  in  sight  is  due  largely  to  the  fatigue 
which  ever  comes  of  the  need  to  make  volitional  efforts  to 
effect  movements  which,  in  ordinary  use,  are  sensually  guided, 
and  are  more  or  less  in  this  view  automatic.  Besides  which 
the  use  of  the  eyes  is  so  incessant  that  it  is  impossible  for  the 
victims  by  any  means  save  glasses  to  put  the  eyes  at  rest;  so 
that  often  the  strain  is  nearly  incessant. 

The  profound  and  far-reaching  importance  of  these 
conclusions  of  Dr.  Mitchell  .will  not  be  adequately 
recognized  for  generations.     Since  he  established  them 


ASTIGMATISM   AND    EYE-STRAIN.  i93 

many  an  American  oculist  has  personally  seen  thou- 
sands of  such  cases  in  which,  as  if  by  miracle,  lives 
have  been  changed  from  abject  misery  to  happiness. 
As  he  looks  over  the  world,  and  especially  the  Euro- 
pean world,  he  knows  that  there  are  millions  suffering 
in  the  same  way  who  could  be  immediately  cured  were 
it  not  for  the  false  conception  of  astigmatism  and  other 
forms  of  ametropia  entertained  by  medical  men  and 
ophthalmologists.  For  the  genius  that  first  recognized 
the  truth  and  for  the  fearlessness  that  published  it  no 
honor  is  too  great. 

Several  weighty  improvements,  however,  .were  still 
needed  to  give  the  discovery  that  accuracy  and  prac- 
tical usefulness  which  should  make  it  play  in  the  world 
its  role  of  splendid  beneficence.     These  were: 

1.  The  extension  of  the  method  of  estimating  and 
correcting  astigmatism  to  the  hyperopic,  compound 
hyperopic,  mixed,  irregular,  and  unsymmetric  varie- 
ties. This  was  done  largely  by  the  Philadelphia  spe- 
cialists contemporary  with  Mitchell.  The  astigma- 
tism observed  before  Dyer  was  myopic,  a  very  small 
portion  of  that  existing,  and  relatively  speaking  pro- 
ducing few  reflexes. 

2.  The  practical   correction  of  anisometropia.     All 

text-books  up  to  1892  taught,  in  the  language  of  the 

German  master,  Fuchs,  that 

"  In  anisometropia  we  give  the  same  glasses  for  both  eyes, 
or  correct  only  one  eye  and  place  a  plain  glass  before  the 
other." 


194  BIOGRAPHIC    CLINICS. 

This  pernicious  error  was  controverted,  so  far  as  I  am 
aware,  for  the  first  time  in  1892.^  It  was  contended 
that  it  is  unmedical,  unprofessional,  and  unnecessary 
to  leave  an  amblyopic  eye,  injured  from  disuse,  to  its 
fate. 

3.  The  bifocal  spectacles.  An  American  genius, 
Benjamin  Franklin,  invented  bifocal  lenses  for  use  in 
presbyopia,  and  an  important  improvement,  the  "  ce- 
ment bifocal,"  was  adopted  in  1888  by  Philadelphia 
physicians.  These  devices  have  been  of  vast  service 
in  lessening  and  extinguishing  the  evil  effects  of  eye- 
strain in  presbyopes. 

4.  The  perfecting  and  making  practical  of  the  ait 
of  retinoscopy.  This  was  also  the  work  of  Philadel- 
phia specialists.  Only  by  this  method  can  there  be 
accuracy  of  diagnosis  of  ametropia  in  children  and  in 
the  amblyopic. 

5.  The  recognition  of  the  pernicious  influence  of 
eye-strain  upon  the  digestive  and  assimilative  system, 
in  the  production  of  functional  gastric  and  intestinal 
diseases,  of  chorea,  of  hysteria,  of  epilepsy,  etc.  This 
has  been  brought  about  by  the  advocacy  of  other  spe- 
cialists of  Philadelphia  or  by  their  pupils  located  else- 
where. 

6.  The  repression  of  unprofessional  methods,  e.  g., 
the  operative  manias  of  the  tenotomists ;  the  attempted 

* "  Amblyopiatrics,"  by  George  M.  Gould,  M.D.,  Medical 
News,  December  31,  1892. 


ASTIGMATISM   AND    EYE-STRAIN.  19S 

diagnosis  of  ametropia  by  machinery,  the  ophthalmo- 
scope, ophthalmometer,  etc.;  the  uselessness  and  inac- 
curacy of  diagnoses  made  without  cycloplegia;  the 
medical  barbarism  of  the  refracting  opticians,^  etc. 
These  things  bring  discredit  upon  the  true  science  of 
ophthalmology. 

7.  The  evil  psychologic  influence  of  eye-strain. 
This  was  first  pointed  out  by  a  Philadelphia  oculist  in 
1888.  Children  suffering  from  ametropia  have  their 
intellects  and  dispositions  warped,  injured,  or  wrecked. 
The  subtle  malign  influence  of  eye-strain  upon  charac- 
ter is  of  enormous  importance. 

8.  The  economic  and  social  significance,  both  public 
and  personal,  of  the  correction  of  eye-strain.  A  life 
may  be  handicapped  in  its  usefulness  or  even  wasted 
without  such  correction.  Eye-strain  is  one  of  the 
great  causes  of  weakening  of  vital  resistance,  so  that 
other  diseases  secure  easier  foothold.  It  causes  in- 
flammatory and  operative  diseases  of  the  eye.  It 
creates  many  of  the  defective  and  criminal  classes.  It 
is  so  large  an  unrecognized  expense  item  in  our  educa- 
tional and  school  system  that  it  would  pay  the  State, 

^  These  are  becoming  more  and  more  scarce  in  Philadelphia, 
and  consequently  there  is  a  growing  class  of  honorable  firms 
who  take  pride  in  their  true  function  and  from  whom  patients 
can  get  such  serviceable  and  scientific  work  as  the  "  eyes- 
examined-free "  men  never  dreamed  of  doing.  The  optician 
must  no  more  sell  glasses  than  the  druggist  poisons  without  a 
physician's  prescription. 


196  BIOGRAPHIC    CLINICS. 

cities,  and  institutions  of  learning  to  have  an  official 
oculist  whom  every  pupil  and  student  having  no  pri- 
vate oculist  should  consult. 

There  is  thus  a  genuine  significance  in  the  term  The 
Philadelphia  School  of  Ophthalmology.  It  is  that  to- 
day a  hundred  or  more  conscientious  and  skilled  ocu- 
lists in  this  city  are,  before  and  above  all,  physicians, 
convinced  of  the  clinical  value  of  refraction  when  esti- 
mated by  subjective  tests  under  cycloplegia,  in  curing 
numerous  types  of  headache,  neuralgia,  vertigo,  func- 
tional diseases  of  digestion,  assimilation,  and  of  the 
nervous  system.  They  also  know  that  such  diagnoses 
and  such  cures  cannot  be  made  by  the  methods  in 
vogue  in  Europe,  and  that  the  great  clinical  value  of 
refraction  consists  precisely  in  preventing  those  inflam- 
matory and  operative  diseases  of  the  eyes  which  make 
up  the  daily  practice  of  the  vast  majority  of  the  ocu- 
lists of  the  world.  Learning  their  art  directly  or  in- 
directly from  the  so-called  Philadelphia  school,  hun- 
dreds of  oculists  are  finding  a  noble  lifework  through- 
out the  United  States,  and  are  giving  a  million  patients 
the  indubitable  proof  of  personal  experience  that  eye- 
strain is  the  cause  of  terrible  and  varied  diseases,  the 
cure  of  which,  by  spectacles,  is  one  of  the  greatest 
medical  discoveries  of  the  nineteenth  century. 


RESPONSIBILITIES. 


•97 


CHAPTER  IX. 

RESPONSIBILITIES. 

All  agree  that  the  great  men,  and  especially  the  lit- 
erary and  scientific  geniuses  of  a  nation,  are  its  most 
valuable  assets.  They  belong,  indeed,  to  the  world 
rather  than  to  a  part  of  it,  and  to  civilization  itself. 
No  valuation  can  be  put  upon  their  lives  and  work,  so 
far  are  they  beyond  all  ratings.  So  far  as  money 
goes,  the  aim  of  three  of  the  men  whose  clinical  biog- 
raphies we  have  considered  was  a  mere  living,  provi- 
dence for  the  simplest  wants,  in  order  to  give  for  all 
and  for  all  time  the  priceless  products  of  their  minds. 
The  other  two  men  asked  for  no  material  reward  for 
their  life-work.  All,  however,  beyond  any  other  thing, 
wanted  health  and  freedom  from  suffering,  but  the  life 
of  each  was  one  of  constant  endurance  of  pain  and 
misery.  None  can  know  how  this  fact  crippled  their 
productivity,  and  how  profoundly  it  changed  the  char- 
acter of  their  works.  To  themselves  the  cause  of  their 
afflictions  was  the  most  absolute  and  tormenting  mys- 
tery. When  we  bring  to  a  focus  the  few  hints,  echoes, 
and  traces  of  symptoms  we  may  gather  concerning  the 
cause  and  nature  of  their  diseases,  we  discover  a  most 

remarkable  likeness  of  symptoms,  of  conditions  start- 

199 


200  BIOGRAPHIC    CLINICS. 

ing  them,  and  of  the  method  of  reUef  to  which  all  were 
driven.  By  whatever  name  they  described  their  com- 
plaint, headache,  vertigo,  biliousness,  dyspepsia, 
apathy,  misery,  it  was  closely  and  inevitably  conse- 
quent upon  use  of  the  eyes  in  reading  and  writing,  and 
was  relieved  by  stopping  such  use.  These  men,  pur- 
suing a  literary  occupation,  used  their  eyes  in  this  way 
whenever  they  were  not  actively  exercising,  and  so 
they  naturally  held  that  their  relief  came  from  such 
exercise  in  the  open  air.  It  is  strange  to  us  how  each 
one  of  them  never  once  clearly  saw  the  significance  of 
the  fact,  the  connection  between  ocular  function  and 
suffering,  while  every  day  it  was  plainly  before  their 
attention,  and  even  many  times  expressed  in  words. 
Miss  Barrett  almost  caught  sight  of  the  law  several 
times,  and  if  she  had  been  a  physician  she  might  have 
uttered  it  so  sharply  that  it  would  have  been  recog- 
nized by  the  medical  profession.  And  the  medical 
men  to  whom  they  turned  in  their  agonies  had  no  sug- 
gestion to  offer  as  to  this  terrible  mystery.  The  empty 
words  "  biliousness,"  "  overwork,"  "  indigestion," 
"  heredity,"  etc.,  were  all  they  could  utter,  and  as  for 
therapeutics  the  simplest  said  "  mercury,"  and  the  wis- 
est said  "  walk " !  Each  of  the  patients  was  finally 
reduced  to  treating  himself;  one  settled  on  opium,^ 

^  From  the  Browning  correspondence  I  excerpt : 
"Did  you  walk  past  this  house  on  the  other  side  of  the 
street  Sunday  about  2  o'clock?    I  am  so  near-sighted  that  I 


RESPONSIBILITIES.  201 

another,  after  drug-failures,  on  castor-oil,  a  third  on 
wet-packs,  and  the  fourth  and  fifth  solely  on  walking, 
which  indeed  for  all  was  the  final  and  only  effective 

could  only  see  a  shadow  in  the  dimness— but  the  shadow  had 
— or  seemed  to  have — a  sign  of  you — a  trace  of  you."  (E.  B.  to 
R.  B.,  April  14,  1846.) 

"  My  opium  comes  in  to  keep  the  pulse  from  fluttering  and 
fainting — to  give  the  right  composure  and  point  of  balance  to 
the  nervous  system.  I  don't  take  it  for  my  spirits  in  the  usual 
sense;  you  must  not  think  such  a  thing."  (E.  B.  to  R.  B.,  Vol. 
I,  p.  277.) 

"Do  you  care  so  much  about  the  opium?  Then  I  must  care 
—and  get  to  do  with  less  at  least.  ...  It  might  strike  you  so 
strange  that  I,  who  have  no  pain,  no  acute  suffering— should 
need  opium  in  any  shape.  But  I  have  had  restlessness  till  it 
made  me  almost  mad— at  one  time  I  lost  the  power  of  sleeping 
quite— and  even  in  the  day  the  continual  aching  sense  of  weak- 
ness has  been  intolerable.  So  the  medical  man  gave  me  opium." 
(Ibid.,  p.  45I-) 

"  You  wonder  how  I  can  spend  quarterly  the  forty  pounds 
that  come  to  me?  I  do  spend  them.  .  .  .  My  greatest  personal 
expense  lately  has  been  the  morphine."     (Ibid.,  p.  399.) 

All  through  the  correspondence  and  in  the  life  of  Mrs. 
Browning  there  are  vague  allusions  to  headache  and  ill-health. 
At  the  age  of  fourteen  when  saddling  her  pony  she  had  fallen 
backward,  and  hurt  her  spine.  This  caused  her  a  great  deal 
of  suffering,  "  the  nature  of  which  remained  for  some  time 
undiscovered."  How  much  or  little  this  was  the  cause  of  her 
life  of  ill-health  must  remain  a  mystery.  And  the  same  may 
be  said  as  regards  her  certainly  existing  ametropia.  Between 
one  and  two  dollars'  worth  of  morphin  a  day  was,  even  in 
1846,  a  large  amount.  Mrs.  Browning  died  years  after  this.  I 
append  the  quotations  as  evidence  of  another  phase  of  the 
question,  and  as  one  more  illustration  of :  "  and  so  the  medical 
man  gave  me  opium." 
14 


202  BIOGRAPHIC    CLINICS. 

cure — though  at  best  but  partially  and  temporarily  so. 
Cure,  of  course,  it  was  not  in  a  strict  sense,  because 
all  genuine  cure  depends  upon  a  knowledge  of  the 
cause  of  the  disease.  The  physicians  of  these  men  did 
not  suspect,  and  thousands  of  the  physicians  of  other 
patients  have  not  suspected  the  cause,  because  of  their 
faulty  observation.  Up  to  a  certain  time,  say  for  the 
last  thirty  years,  this  inaccuracy  of  observation  was 
perhaps  not  blameworthy,  though  one  wonders  that  the 
thousands  whose  official  duty  was  diagnosis  should 
have  been  less  curious  and  quick-sighted  than  Miss 
Barrett.  The  nearest  any  came  to  a  glimpse  of  the 
evident  fact  was  Sir  Andrew  Clark,  with  whom  it  was 
routine  to  order  his  Hterary  patients  to  quit  work  and 
to  travel.  He  evidently  recognized  the  good  result  em- 
pirically but  had  no  insight  of  the  reason  of  the  conse- 
quent improvement  in  health.  It  seems  to  us  now  that 
it  is  a  very  easy  step  in  logic  and  the  analysis  of  symp- 
toms to  see  that  when  reading,  writing,  or  proof-read- 
ing was  always  followed  by  intense  suffering  they 
probably  stood  in  some  causal  relation  to  the  suffer- 
ing.^ Two  of  our  patients  knew  what  the  optical 
powers  of  lenses  meant,  and  all  of  their  physicians 
should  also  have  understood  microscopes;  they  also 
knew  that  the  eyeball  is  an  optical  instrument.     They 

^Even  in  the  time  of  De  Quincey  Dr.  Begbie  noticed  that 
literary  men  and  students  had  headache,  and  that  it  was  to 
them  "a  common  source  of  annoyance  oftentimes  of  misery." 


RESPONSIBILITIES.  203 

would  have  flung  a  microscope  into  the  corner  in  dis- 
gust had  it  been  in  a  small  degree  as  optically  faulty 
as  their  own  eyes,  which  they  used  as  a  part  of  the 
system  of  lenses  in  microscopic  investigations.  And 
one  of  these  microscopists  was  also  a  physiologist. 

If  it  is  to  be  admitted  that  criticism  is  out  of  place, 
as  to  physicians  of  half  a  century  ago,  the  rule  cannot 
obtain  as  to  the  physicians  of  the  last  twenty-five  or 
thirty  years.  In  that  time  astigmatism  and  the  method 
of  its  cure  have  been  the  common  knowledge  of  the 
alert-minded.  In  all  of  that  time  the  evidence  of  the 
influence  of  errors  of  refraction  in  producing  head- 
aches has  been  before  the  scientific  world.  But  few 
medical  men  have  made  that  knowledge  an  integral 
part  of  their  practice,  and  the  vast  body  of  the  pro- 
fession has  ignored  it.  Moreover,  for  ten  or  more 
years  proof  has  been  obtainable  and  offered  that  this 
same  eye-strain  may  and  frequently  does  cause  func- 
tional digestional  disorders.^  And  yet  to-day  learned 
books  are  being  issued  by  learned  physicians,  on  head- 
ache, neurasthenia,  and  stomach  diseases,  which  either 
contain  no  mention  of  eye-strain  as  an  etiologic  factor, 

*  My  first  cases  of  such  reflex  ocular  neuroses  as  flatulent 
and  other  dyspepsias,  cardiac  palpitation,  chorea,  etc.,  were 
reported  with  statement  of  the  general  law  in  the  Medical  and 
Surgical  Reporter,  January  9  and  March  9,  1889,  and  in  the 
American  Journal  of  Medical  Sciences,  January,  1890,  and  in 
the  Journal  of  the  American  Medical  Association,  September 
19,  1891. 


204  BIOGRAPHIC    CLINICS. 

or  such  mere  mention  as  to  make  the  truth  more  stu- 
pidly and  more  superciliously  ignored.  Why  is  this? 
There  are  several  reasons  for  this  strange  and  morbid 
persistence  of  error: 

I.  The  biologic  or  evolutional  history  of  organs  and 
of  disease  is  neglected,  and  often  this  only  can  explain 
present  functions  and  malfunctions.  In  the  day  when 
food  is  far  better,  more  constant,  and  when  the  art  of 
its  preparation  is  most  perfected,  when  life  is  more 
orderly  and  temperate,  dyspepsia  is  said  to  be  far  more 
prevalent  than  ever  before.  The  influence  of  civiliza- 
tion upon  the  eye  is  also  not  recognized  as  being  so 
highly  different  from  that  in  previous  ages  of  man  or 
animal.  The  value  of  vision  to  the  organism  is  so 
great  that  any  other  organ  and  even  all  others  must  be 
made  to  endure  the  injury  rather  than  that  of  vision. 
Hence  the  whole  system  must  often  become  the  vicari- 
ous sufferer  for  the  sins  of  the  eye.  To  this  is  also 
added  the  powerful  action  of  sexual  selection.  The 
eye  is  so  absolutely  essential  to  beauty  that  in  women 
especially,  inflammation,  the  natural  result  of  malfunc- 
tion, must  not  be  allowed  to  harm  its  appearance. 
Headache,  nutritional  and  other  inhibitions,  and  multi- 
form reflex  neuroses,  are  the  inevitable  results.  It  is 
impossible  for  nature,  who  never  made  anything  per- 
fect or  symmetric,  to  make  the  eye  an  optically  per- 
fect instrument,  either  organic  or  functional.  Helm- 
holtz  said  of  the  eye  that  if  his  optician  were  to  send 


RESPONSIBILITIES.  205 

him  such  an  instrument  he  would  return  it  for  altera- 
tions. The  least  optical  imperfection  may  endanger 
the  organism  and  prevent  success,  and  the  efforts  of 
compensation,  especially  in  civilization,  become  as  pain- 
ful as  are  all  excessive  and  continuous  efforts,  and  even 
more  so,  because  of  the  delicacy  of  the  mechanism  and 
the  infinitesimal  nature  of  the  stimulus. 

2.  Modern  medical  science  has  been  expending  all 
its  strength  and  intellect  on  the  discovery  of  the  causes 
of  infectious  disease  and  on  the  treatment  of  organic 
disease.  In  essence  the  plan  was  good  but  the  neglect 
of  other  things  was  not  good.  There  is  a  tragedy  in 
the  neglect  of  non-infectious  and  functional  diseases, 
which  do  not  cause  so  many  deaths,  but  which  do  cause 
vastly  more  direct  suffering  than  the  organic  and  germ 
diseases  combined.  And  the  scientific  medical  man  is 
also  forgetful  of  the  fact  that  functional  disease  is  the 
cause  of  much  organic  disease.  Evolution  itself  is  the 
formation  and  modification  of  habits.  At  least  80 
percent  or  90  percent  of  headaches  and  a  very  large 
proportion  of  digestional  or  nutritional  diseases  are 
dependent  upon  eye-strain,  and  these  headaches  and 
digestional  disorders  together  are  direct  or  secondary 
sources  of  a  large  part  of  the  functional  diseases  and 
misery  of  the  world. 

3.  Science  and  even  medical  science  is  slow  to  recog- 
nize the  unity  of  the  organism  and  the  close  interrela- 
tion of  its  parts.     "  The  passing  of  the  reflex "  has 


2o6  BIOGRAPHIC    CLINICS. 

even  filled  medical  journals  with  jubilations.  But  the 
reflex  remains.  All  physiology,  in  method  of  mechan- 
ism, is  little  else  than  a  system  of  reflexes,  and  there  is 
no  escape  from  the  much  ignored  truth  that  pathology 
is  morbid  or  abnormal  physiology.  Hence  the  origin 
of  the  disease  is  very  frequently  morbid  reflexes. 

4.  The  general  physician  has  not  failed  to  add  to  the 
neglect  of  "  the  ophthalmic  gospel  "  by  consciously  and 
unconsciously  ignoring  v^hat  should  have  been  his 
noblest  opportunity.  "  Curing  "  headache  and  dyspep- 
sia by  drugs  and  vi^ithout  curiosity  as  to  cause,  "  cur- 
ing "  these  in  the  same  patient  at  frequently  recurring 
intervals  for  years — this  is  neither  medicine  nor  morals. 
It  is  an  unpleasant  subject,  a  hateful  truth,  but  one 
must  speak  if  frankness  is  advisable  and  error  w^rong. 
Every  week  books,  editorials,  and  articles  still  appear 
upon  neurasthenia,  vertigo,  headache,  stomach-dis- 
eases, etc.,  in  .which  not  a  word  is  said  as  to  the  great- 
est single  cause  of  these  disorders. 

5.  The  lay  world,  so  far  as  it  has  any  opinion  on  the 
question,  thinks  that  spectacles  are  only  to  enable  one 
to  read  and  write  when  old  age  has  begun  to  appear. 
No  one  likes  to  admit  the  oncoming  of  old  age,  even 
to  himself,  and  so  profound  is  the  influence  of  pride 
and  sentiment  that  they  have  been  potent  causes  in 
preventing  the  needed  adoption  of  one  of  the  greatest 
reforms  and  blessings  in  the  world.  "  It  is  so  sad  to 
see  bespectacled  children  and  young  people !  "     But  if 


RESPONSIBILITIES.  207 

they  are  needed  it  is  infinitely  more  sad  to  see  them 
without  spectacles. 

6.  There  is  an  almost  universal  belief  on  the  part 
of  the  laity  that  glasses  are  not  needed  because  the 
(distant  or  about-the-room)  vision  is  good  or  supposed 
to  be  perfect.  "  If  the  eyes  do  not  hurt,  and  the  vision 
is  good,  then,"  the  popular  logic  is,  "  of  course  glasses 
cannot  be  needed."  The  truth  is  that  the  morbid  dis- 
tant reflexes  to  the  head,  stomach,  etc.,  take  place  only 
when  the  vision  is  good  and  the  eyes  do  not  suffer.  It 
is  when  the  neutralization  of  the  ametropia  is  possible 
and  is  attained  with  intense  though  perhaps  uncon- 
scious exertion,  when  the  eye  does  not  suffer  or  lose 
clearness  of  vision — it  is  then  that  most  commonly 
appear  the  reflexes  of  dyspepsia,  biliousness,  headache, 
etc. 

7.  The  want  of  the  requisite  accuracy  and  scientific 
attention  to  detail  on  the  part  of  the  oculists  makes  it 
difficult  in  the  greater  part  of  the  civilized  world  to 
obain  a  diagnosis  of  errors  of  refraction  which  shall 
be  so  precise  as  to  give  relief  of  the  suffering  that 
flows  from  them.  Few  even  of  scientific  men  realize 
the  infinitesimal  conditions  and  forces  they  are  dealing 
with.  The  eye  responds  to  a  stimulus  many  millions 
of  millions  times  more  slight  than  the  ear;  the  entire 
defects  of  the  eye  upon  which  eye-strain  depends,  con- 
cern only  1/200  or  1/300  of  an  inch  in  the  measure- 
ments of  diameters  and  curves;  the  evolution  of  the 


2o8  BIOGRAPHIC    CLINICS. 

eye  is  such  that  civiUzation  puts  it  to  a  new  function 
in  recent  years  for  which  it  was  not  created  or  hab- 
ited. The  success  of  the  animal  or  savage  depended 
on  sharp  distant  vision;  that  of  the  city-dweller  usu- 
ally on  sharp  near  vision,  which  requires  a  different 
ocular  mechanism. 

8.  Oculists  have  also  trusted  too  much  in  instru- 
ments and  the  objective  methods  of  diagnosing  ame- 
tropia. The  subjective  method,  with  mydriasis,  when, 
as  is  usual,  it  is  possible,  is  the  sole  reUable  method. 
It  is  physiologic  optics  with  which  we  have  to  deal,  not 
mechanic;  the  living  ever-varying  eye,  not  the  refrac- 
tion, e.  g.,  of  a  piece  of  glass.  There  is  in  all  medicine 
no  work  requiring  such  untiring  patience,  almost  in- 
finite expertness,  and  broad-minded  perfection  of  judg- 
micnt,  as  the  solution  of  the  problems  of  refraction. 

9.  Ophthalmologists  have  been  derelict  in  their  duty 
in  giving  way  to  popular  prejudice,  in  seeking  surgi- 
cal success,  while  indifferent  to  the  higher  and  nobler 
function  of  preventing  disease  by  means  of  the  relief 
of  eye-strain.  Men  nine-tenths  of  whose  office  work 
and  income  is  from  refraction  will  make  up  their  so- 
ciety programs  with  papers  nine-tenths  of  which  con- 
cern operations,  tumors,  and  inflammatory  diseases. 

10.  Scientific  ophthalmology  has  been  hurt  by  the 
absurd  faddism  of  the  muscle-cutters.  The  failure  of 
their  wild  enthusiasm  and  exaggerated  claims  has  nat- 
urally disgusted  the  professional  and  lay  world  with 


RESPONSIBILITIES.  209 

the  whole  specialty,  and  in  this  way  has  withdrawn 
attention  from  refraction,  the  real  source  of  manifold 
reflexes  and  of  muscle-imbalances  themselves. 

II.  In  his  proper  art  and  work  the  optician  has  usu- 
ally been  so  backward,  and  in  his  impertinence  and 
assumption  so  forward,  that  both  have  conspired  to 
engender  disappointment  and  disgust.  Few  opticians 
can  rightly  do  their  legitimate  work,  the  making  and 
fitting  of  spectacles.  And  this  is  because  they  are 
striving  to  do  the  physician's  duty.  It  should  be  as 
illegal  and  impossible  for  an  optician  to  sell  a  pair  of 
lenses  without  a  physician's  prescription  as  it  is  for 
a  druggist  to  sell  poison  without  medical  warrant. 
The  latter  kills  instantly,  the  other  slowly. 

I  have  chosen  to  study  only  five  men  whose  occupa- 
tion demanded  much  "  near  work  "  with  their  eyes. 
Those  selected  have  been  such  as  the  accidents  of  bor- 
derland reading  called  to  my  attention.  In  the  lives 
of  a  number  of  others  I  found  no  suggestion  of  the 
pernicious  influence  of  eye-strain  upon  life  and  labor. 
In  the  biographies  and  letters  of  others  there  are  the 
most  striking  suggestions  of  this  truth,  but  however 
convincing  to  me,  they  would  not  at  present  be  so  to 
others.  The  Berlin  oculist  Liebreich  was  certain  that 
the  peculiar  character  of  Turner's  pictures  was  due  to 
his  astigmatism,  and  that  if  they  are  viewed  through 
proper  astigmatic  lenses,  these  paintings  would  appear 
as   those   of   other  painters   with   normal   eyes.     The 


2IO  BIOGRAPHIC    CLINICS. 

musician  Tschaikowsky  was  troubled  all  his  life  by 
sleeplessness,  fatigue  and  depression,  and  in  his 
thirty-seventh  year  he  had  a  complete  nervous  col- 
lapse. The  necessity  of  gleaning  the  few  significant 
clinical  facts  of  a  man's  life  from  the  modern  slip- 
shod, unworkmanlike,  unindexed  biography,  .with  its 
inattention  to  those  matters  of  the  most  profound  im- 
portance, makes  it  difficult  in  the  few,  but,  impossible 
in  the  many,  to  get  the  data  for  making  up  a  true 
picture  of  the  real  physical  and  physiologic  man. 
Doubtless  many  other  literary  and  scientific  workers 
have  been  and  still  are  sufferers  from  the  same  cause 
as  the  five  cited.  Surely  the  foolish  excuse  offered 
that  their  great  mental  labor  caused  their  ill-health  is 
the  veriest  nonsense.  Their  mental  strain  was  no 
greater  for  them  than  it  is  for  thousands  of  their  col- 
leagues, and  for  millions  of  workers  in  other  fields  of 
intellectual  labor.  The  particular  lesson  of  their  lives 
is  of  value  as  we  learn  and  apply  it  to  others  who  are 
to-day  enduring  the  same  agonies,  unconscious,  as  were 
they,  of  the  true  nature  of  their  malady.  The  saying 
that  "  genius  breeds  upon  dyspeptic  soil,"  is  as  stupidly 
untrue  as  any  ever  devised  by  ignorance  and  conceit. 
And  not  only  for  the  great  and  famous,  the  sound  of 
whose  complaining  may  come  to  our  ears,  but  for  the 
millions  of  the  slaves  of  civilization  who  complain  only 
to  their  nearest  friends  and  to  their  family  physician. 
Eye-strain  is  crippling  the  mental,  moral,  and  physical 


RESPONSIBILITIES.  2 1 1 

health  of  a  certain  proportion  of  all  school  children  and 
students.  I  believe  this  proportion  is  larger,  but  let  us 
say  that  it  is  only  one  in  ten ;  that  in  the  civilized  world 
.would  include  at  least  10,000,000  to  15,000,000.  Then 
there  are  the  clerks,  the  hand  workers  in  manufactur- 
ing industries,  the  seamstresses,  etc. — the  large  major- 
ity of  the  inhabitants  of  civilized  countries — whose  eyes 
are  put  to  the  same  strain,  and  a  certain  portion  of 
whom  we  know  have  astigmatic  and  other  ocular  de- 
fects causing  eye-strain. 

There  are  several  ways  of  answering  the  indifferen- 
tist  and  the  unconvinced.  The  question  is  capable  of 
easy  and  certain  decision,  so  soon  as  the  present  indo- 
lent skepticism  shall  give  way  to  intelligent  interest. 

1.  Examine  the  evidence!  There  are  hundreds  of 
honorable  conservative  physicians  who  have  put  their 
experiences  on  record  or  who  would  willingly  testify 
that  eye-strain  is  often  the  cause  of  the  disorders  such 
as  those  of  our  five  patients.  It  would  be  easy  to 
gather  from  medical  literature  an  astonishing  mass  of 
reports  of  cures  of  these  affections  by  the  relief  of  eye- 
strain. The  suggestion  would  call  up  in  the  minds  of 
most  American  oculists  memories  of  a  large  number  of 
patients  who  have  been  cured  in  this  way  of  precisely 
the  same  symptoms  as  those  of  the  five  examples  chos- 
en. I  know  one  who  would  bring  the  proofs  of  several 
thousands  of  such  cures. 

2.  Make  the  actual  test.     Every  person  has  several 


212  BIOGRAPHIC    CLINICS. 

acquaintances  who  are  great  sufferers  from  headache, 
"  biliousness,"  vertigo,  dyspepsia,  etc.,  not  due  to 
organic  disease.  Let  such  a  person  be  taken  to  an 
expert  refractionist,  and  if  spectacles  are  needed,  let 
them  be  prescribed  after  cycloplegia  and  subjective 
testing.  If  one  case  does  not  convince,  there  is  no  diffi- 
culty in  finding  subjects  for  a  hundred  repetitions. 

3.  Try  the  test  for  differential  diagnosis — the  in- 
stillation, the  patient  being  under  professional  care,  in 
the  eyes,  once  daily,  of  a  solution  of  atropin  (four 
grains  to  the  ounce),  for  ten  days.  If  the  symptoms 
are  due  to  eye-strain,  and  if  not  so  chronic  as  to  have 
induced  organic  changes,  the  paralysis  of  the  muscle 
of  accommodation  will  give  almost  immediate  relief. 

4.  Reverse  a  few  tests.  There  are  many  thousands 
of  American  patients  who  have  learned  that  the  spec- 
tacles they  have  been  wearing  cured  them  of  these 
symptoms  and  who  find  that  when  the  refraction 
changes,  as  it  often  does,  when  lenses  are  broken  or 
badly  fitted,  there  is  at  once  a  return  of  the  old  symp- 
toms. Secure  the  cooperation  of  such  patients  in 
human  vivisection  experimentation,  and  get  them  to 
stop  wearing  their  glasses  for  a  week  or  two. 

5.  Produce  the  symptoms  in  a  new  case.  Take  a 
well  and  uncomplaining  person  and  get  him  (or  her) 
to  wear  a  pair  of  astigmatic  and  anisometropic  spectacle 
lenses,  the  same  as  are  prescribed  by  oculists  for  the 
cure  of  these  reflex  symptoms.     Such  spectacles  will 


RESPONSIBILITIES.  2 1 3 

produce  artificially  the  same  ametropia  as  exists  nat- 
urally in  other  patients,  and  they  will  also  produce  the 
symptoms  complained  of  by  Darwin  and  the  rest. 

This  theory  is  at  least  a  working  hypothesis,  and  as 
there  is  admittedly  no  other  scientific  etiology  of  these 
affections  worth  consideration,  and  no  cure  that  cures, 
it  behooves  the  entire  profession  to  test  the  hypothesis 
most  seriously  and  vigorously.  Mere  indifference, 
neglect,  or  contempt,  will  not  longer  answer  the  de- 
mands either  of  an  earnest  philanthropy,  or  of  a  digni- 
fied science. 


INDEX. 


Accommodation  failure — in  Carlyle 70 

in   Darwin 98 

in  De  Quincey 35 

in  Huxley 120 

Accommodative  effort  ceases  in  walking 30 

Aphoses,  part  of  in  resensitizing  retina 160 

Arteries  and  veins  of  eye,  part  of  in  resensitizing  retina..  ..  160 

Artificial  light  in  1780-1870 35 

Artificial  lighting,  necessary  reform  in  methods  of 168 

Astigmatic   lens,    invention   of 181 

Astigmatism   and  eye-strain,   discovery  of i73 

and  eye-strain,  prevalence  of 211 

diagnosis  of,  methods  used  by  Dr.  Dyer 182 

effect  of  relieved  by  opium 39 

in  Browning's  case 136 

in  Carlyle's  case 65 

in  Darwin's  case 103 

in  De  Quincey's  case 34 

in  Huxley's  case 117 

physiology    of 1 74 

recognition   of  pathologic  significance 184 

Biliousness  and  Headache 143 

and    quackery I45 

Carlyle's 66,  67 

Binocular  vision,  function  of 163 

Browning    125 

clinical  facts  concerning 122 

Browning's  ailment  and  heredity X38 

astigmatism   136 

215 


2i6  INDEX. 

Browning's  exercise  in  the  open  air 133,  139 

health  in  youth 132 

physiologic  habits 132 

Carlyle    41 

and  De  Quincey 23 

clinical  facts  concerning 43 

exercise  in  the  open  air . .  ,  ^. 61 

first  appearance  of  symptoms 57 

Carlyle's — biliousness   66,  67 

constitution    S8 

complaints,  Froude's  interpretation  of 62 

"  gastrodynia  "    68 

insomnia 60 

lesson  on  health 73 

opinion  of  the  medical  profession 66 

physiologic  habits 59 

second  critical  period 60 

self-medication    65 

symptoms  62 

use  of  tobacco 59 

work  and  symptoms,  a  comparison 69 

Cases  of  Carlyle,  Huxley,  Darwin,  and  Browning  compared..  134 

Case-records,  preservation  of 12 

Character  influenced  by  eye-strain 88 

Charles    Darwin 77 

Clinical  data — concerning  Browning 127 

concerning    Carlyle 43 

concerning    Darwin 79 

concerning  De  Quincey 17 

concerning    Huxley 109 

life-problem  of  patients  must  be  studied 10 

Comparison  of  cases  of  Darwin,  Huxley,  Carlyle,  and  Brown- 
ing    134 

Constipation  and  eye-strain 66 

Critical  period,  second — of  Carlyle 60 

of  Darwin 97 


INDEX.  217 

Critical  period,  second— of  De  Quincey 32 

of  Huxley 117 

Cylindric  lenses,  first  made  in  America 1 78 

Darwin 77 

clinical  facts  concerning 79 

and  presbyopia 102 

Darwin's — alleged  sea-sickness,  explanation  of 90 

early  life,  idleness  of 89 

father's  diagnosis 95 

first  two  years  ashore 95 

literary  product 103 

loss  of  physical  vigor 99 

period  of  accommodation  failure 98 

second  critical  period 97 

South  American  illness 94 

state  as  analyzed  by  Dr.  W.  W.  Johnston 104 

symptoms  and   "  neurasthenia  " 106 

Definition  of  eye-strain 150 

De  Quincey  i5 

and  Carlyle .^ 23 

beginning  of  headaches 27 

clinical  facts  concerning i7 

conscious  of  eye-trouble 35 

disease  from  which  he  suffered 34 

evidences  of  exophoria 36 

exercise  in  the  open  air 29 

first  use  of  opium 28 

nonuse  of  spectacles 38 

portrait,  deductions  from 36 

use  of  but  one  eye 37 

De  Quincey's — attack  of  "  nervous  horror  " 29 

dreaming  tendencies 25 

relapses  into  opium-addiction 3i 

Diagnosis — by  Darwin's  father 95 

differential,  in  eye-strain 212 

of  astigmatism  by  Dr.  Ezra  Dyer 182 

15 


2i8  INDEX. 

Diagnosis  of  Darwin's  state  by  Dr.  W.  W.  Johnston 104 

Differential  diagnosis  in  eye-strain 212 

Digestional  disorders  and  eye-strain 203 

Discovery  of  astigmatism  and  eye-strain 173 

Disease — from  which  De  Quincey  suffered 34 

not  caused  by  intellectual  activity 70,  99,  120 

phases  of  interesting  to  the  profession 9 

Dreaming-tendencies  of  De  Quincey 25 

Dyer,   Ezra — and  diagnosis   of  astigmatism 182 

first  use  of  test-types 183 

Dyspepsia,   beginning  of — in   Carlyle 58 

in  Darwin 100 

in  De  Quincey 33 

in    Huxley 116 

Effect  of  early  study  on  Darwin 90 

Etiologic  factor,  eye-strain  as  an 204 

Exercise — Darwin's  loss  of  ability  for 99 

in  open  air  and  accommodative  effort 30 

by    Browning 133,  139 

by   Carlyle 61 

by  De  Quincey 29 

by  Huxley 115 

physical,  necessity  for 30 

Exophoria,    De    Quincey 36 

Experimentation  proof  of  effects  of  eye-strain 212 

Eye,  use  of  but  one  by  De  Quincey 37 

Eyebrow — function    of 163 

growth  of  in  old  age 164 

Eye-defect — analysis   of  Browning's 136 

of  Carlyle's 64 

of  Darwin's 98 

of  De  Quincey's 36 

of  Huxley's 121,  122 

Eyelashes,  function  of  the 162 

Eyes,  constant  movement  of 163 

Eye-strain    and    astigmatism,    discovery    of 173 


INDEX. 


219 


Eye-strain — and  astigmatism,  prevalence  of 211 

and   constipation 66 

and  digestional  disorders 203 

and  insomnia 33 

as  an  etiologic  factor 13,  24,  204 

defined  150 

De  Quincey  conscious  of 35 

differential  diagnosis  in 212 

experimentation  proof  of  effects  of 212 

factor  in  functional  diseases 13,  24,  204 

influence  of  on  disposition,  character,  vocation,  etc. ...    28,  88 

recognition  of  pathologic  significance  of 184 

reflexes  of 204 

Failure   of   accommodation — in    Carlyle 70 

in   Darwin 98 

in  De  Quincey 35 

in  Huxley 120 

Fatigue  of  retina  and  reestablishment  of  sensibility 159 

Froude's — interpretation   of    Carlyle's    complaints 62 

self-contradictions    58 

Functional  diseases — eye-strain   a  factor  in 13,  34,  204 

ignoring  of 149,  205 

"  Gastrodynia  " — as  Carlyle's  ailment 68 

and  De  Quincey 22 

Habits,  physiologic — of  Browning 132 

of    Carlyle 59 

Hats,  reason  for  wearing 165 

Headache  and  biliousness 143 

Headaches — ametropic     31 

beginning  of  De  Quincey's 2^ 

recurring,  "  cure  "of 206 

study  of 152 

Health — Carlyle's   lesson   on 73 

of  Browning  in  youth 132 

"  Heart-disease  "  and  Huxley's  ill-health 115 

Heredity  and  Browning's  ailment 138 

Horror,  nervous,  De  Quincey's  attack 39 


220  INDEX. 

Humoral   pathology i44 

Humoral  theory,  the 143 

Humors  of  the  Body I43 

Huxley    109 

and  astigmatism 117 

and  presbyopia 117 

beginning  of  dyspeptic  symptoms 116 

Huxley's — exercise  in  the  open  air 115 

eye-defect,  analysis  of 117 

habits  of  study 114 

"  heart-disease "    115 

partial   relief   from   symptoms 121 

Ignoring  of  functional  diseases 149,  205 

Ill-health — and  intellectual  effort 70,  99,  120 

Browning's,  and  heredity 138 

of  Huxley  and  "  heart-disease  " 115 

Illness  of  Darwin  in  South  America 94 

Insomnia — and    eye-strain 33 

of  Carlyle 60 

Intellectual  effort  and  ill-health 70,  99,  120 

Introduction    9 

Invention  of  astigmatic  lens 181 

Iris  pigmentation 162 

Johnston,  Dr.  W.  W.,  opinion  of  Darwin's  ailment 104 

Knowledge  without  health  valueless 7 

Lens,  astigmatic,  invention  of 181 

Lenses,  cylindric,  first  made  in  America 178 

Life-histories,  clinical,  and  physiologic,  of  patients 12 

Life  influenced  by  eye-strain 88 

Life-problem  of  patients  most  important 10 

Lighting,   artificial — in    1 790-1870 35 

reform  in  methods  of 168 

Literary  product — Carlyle's 71 

Darwin's 103 

Medical  profession,  Carlyle's  opinion  of 66 

Mitchell,  Dr.  S.  Weir,  recognition  of  pathologic  significance 

of  astigmatism 184 


INDEX,  221 

Mottoes   7 

Movement  of  eyes 163 

Muscae  volitantes,  part  of  in  resensitizing  retina 161 

Mydriasis,    necessity    for 208 

Necessity — for  mydriasis 208 

for  physical  exercise 30 

Neglect  of  functional  diseases 149,  205 

Nervous  horror,  De  Quincey's  attack 29 

"  Neurasthenia  "  and  Darwin's  symptoms 106 

Ocular  headaches 31 

Ophthalmology,  Philadelphia  School  of 196 

Opium-addiction,  De  Quincey's  relapses 31 

assistance  of,  in  relieving  effect  of  astigmatism 39 

De  Quincey's  first  use  of 28 

effect  of,  on  the  teeth 24 

Optician,  duties  of 24 

Pathogeny   of   disease   interesting  to   philosophic   physicians 

only   10 

Patient's  entire  history  makes  life-problem 10 

Philadelphia  School  of  Ophthalmology 196 

Phosphenes,  part  of  in  resensitizing  retina 160 

Picture-frames,  effect  of  on  vision 167 

Pigmentation — around  the  eye 161,  162 

of  iris 162 

Pigment  of  retina,  part  of  in  conserving  sensitization  of  the 

retina   161 

Physician,  true,  usefulness  of 7 

Physiologic  habits — of  Browning 132 

of  Carlyle 59 

Physiology — of    astigmatism 174 

of  vision,  some  neglected  points  in 158 

Presbyopia — and    Huxley 117 

influence  upon  Darwin 102 

on  Carlyle 58 

Prevalence  of  astigmatism  and  eye-strain 211 

Pupil,  alternate  contraction  and  dilation  of 162 

Quackery  and  biliousness 145 


2  22  INDEX. 

Recurring  headache,  "  cure  "  of 206 

Reflexes,  increased  intensity  during  failure  of  accommodation .  32 

of  eye-strain 204 

Responsibilities   199 

Retina,  how  it  is  resensitized 160 

Retinal — fatigue  and  reestablishment  of  sensibility 159 

pigment,  conserving  action  in  sensitization  of  retina....  161 

resensitizing,  part  of  muscae  volitantes 161 

part  of  phosphenes,  phoses,  or  aphoses i6o 

part  of  veins  and  arteries 160 

Robert  Browning 127 

Science  justified  by  verification 7 

Sea-sickness,  Darwin's  alleged  explanation  of 90 

Self-medication,    Carlyle's 65 

Some  Neglected  Points  in  the  Physiology  of  Vision 158 

Spectacles — careless    use    of 65 

non-use  of  by  De  Quincey 38 

when  needed,  popular  ideas  concerning 207 

Stimulus,  interruption  of  in  retinal  function 164 

Stomach   disorder — Carlyle's 58 

Darwin's 100 

De  Quincey's 33 

Huxley's  116 

Study,  Huxley's  habits  of 114 

Study  of  headaches 152 

Symptoms — and  work,  Carlyle's, — a  comparison 69 

Carlyle's   62 

late  appearance  in  Carlyle 57 

partial  relief  of  in  Huxley 121 

Systematic  and  periodic  study  of  phyiologic  and  medical  tests 

of  patients  throughout  life 12 

Teeth  and  opium 24 

Test-types,  first  used  by  Dyer 183 

The  Discovery  of  Astigmatism  and  Eye-strain 171 

Thomas  Carlyle 43 

Thomas  De  Quincey 17 

Thomas  H.  Huxley 109 


INDEX.  223 

Tobacco,  use  of  by  Carlyle 59 

'Tschaikowsky,  probable  astigmatism  of 210 

Turner,  probable  astigmatism  of 210 

Usefulness  of  true  physician 7 

Veins  and  arteries  of  eye,  part  played  in  resensitizing  the 

retina    160 

Verification  the  justification  of  science 7 

Vision — binocular,    function    of 163 

some  neglected  points  in  physiology  of 158 

Vomiting,  Darwin's 100 

Walking  and  accommodative  effort 30 

effect  on  ocular  accommodation  and  reflexes 30 

necessity  for  in  persons  suffering  from  astigmatism 30 

Winking,   function  of 162 

Work  and  symptoms,  Carlyle's — a  comparison 69 

Yellow  choler 145 


UNIVERSITY   Ot   CALltUmMA   i.ioiv/vxvi 

Los  Angeles 
This  book  is  DUE  on  the  last  date  stamped  below. 


*  NOV  17  1963 

■■      HOVlORECT) 

HEC'D  LD-URU 


13/ 


10(2554)444 


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